Suicide Ratio Research Articles

Suicide and Types of Agriculture: A Time-Series Analysis in Japan.

ObjectiveIn recent years, rural areas have reported higher suicide rates than urban areas worldwide. Although agricultural activity is a key characteristic of many rural areas, rurality may also have heterogeneous qualities based on the type of agriculture pursued. However, to date, no study has examined potential linkages between suicide rate and types of agriculture.MethodIn this study, we used 1983–2007 annual time‐series data of the standardized mortality ratio (SMR) of suicide and product‐specific agricultural outputs in Japanese municipalities to shed light on this phenomenon. We conducted a multilevel linear regression analysis, taking into account a hierarchical structure of the time‐series data, limiting our analysis to municipalities where agricultural land use was high.ResultsOur multilevel analysis showed that the animal husbandry output was positively associated with suicide SMR in both women and men, with a stronger relationship among women, whereas no association was observed in agricultural crop output. Temporal analysis showed that the association could be observed consistently throughout the period between 1983 and 2007.ConclusionsThis study raises the possibility that the industrial and cultural characteristics of communities that rely on animal husbandry may be associated with an increased risk of suicide.

Maternal suicide in Italy.

Suicide has been identified as one of the most common causes of death among women within 1year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006-2012. The suicide rate was 1.18 per 100,000 after giving birth (n= 2,876,193), 2.77 after an induced abortion (n= 650,549) and 2.90 after a miscarriage (n= 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.

Association between telomere length and completed suicide observed in 71 suicide victims – Preliminary findings

ObjectiveTelomere length has emerged as a cumulative marker for lifestyle, psychosocial stress, and cytotoxic environments. We aimed to examine the possible association between leukocyte telomere length (LTL) and completed suicide. MethodsThis study included 71 suicide completers and 117 healthy controls for whom LTL was determined by the ratio of the telomere repeat copy number to the single-copy gene copy number (T/S ratio). We compared the LTL between the suicide completers and the healthy controls and estimated the odds ratio (OR) for suicide for each age group, applying a generalized estimating equation (GEE). ResultsLTL was significantly shortened in the suicide completers as compared with the controls, overall subjects, or within-age categories (≤29 and 30–49 years). Furthermore, a longer LTL was associated with significantly decreased odds of completed suicide for those aged ≤29 years and 30–49 years (OR = 0.11, 95% confidence interval [CI] 0.03–0.37, p < .001 for the ≤29-year age group; OR = 0.54, 95% CI 0.34–0.84, p = .006 for the 30- to 49-year age group). ConclusionsThis study provides evidence regarding the relationship between shortened LTL and completed suicide, especially in those aged <50 years. Future research should further assess potential confounders and examine underlying mechanisms.

Suicide among cancer patients

Our purpose is to identify cancer patients at highest risk of suicide compared to the general population and other cancer patients. This is a retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1973-2014. Among 8,651,569 cancer patients, 13,311 committed suicide; the rate of suicide was 28.58/ 100,000-person years, and the standardized mortality ratio (SMR) of suicide was 4.44 (95% CI, 4.33, 4.55). The predominant patients who committed suicide were male (83%) and white (92%). Cancers of the lung, head and neck, testes, bladder, and Hodgkin lymphoma had the highest SMRs ( > 5-10) through the follow up period. Elderly, white, unmarried males with localized disease are at highest risk vs other cancer patients. Among those diagnosed at < 50 years of age, the plurality of suicides is from hematologic and testicular tumors; if > 50, from prostate, lung, and colorectal cancer patients.

Global Gender Gap on Suicide: Why are Men More at Risk?

The present study investigates the gender difference in suicidal behavior using principal component analysis (PCA). A huge database was retrieved globally for increased validity and effect. Additionally, regression relationship for estimating the suicidal rate of men, based on the selected factors from the PCA, was developed. The PCA showed three components of vital factors that explains 79.9% of the variation of all variables. The study used male and female suicide rate, HIV/AIDs prevalence, tertiary enrolment, democracy, professional psychiatrist, GDP per capita and unemployment indices across countries as of 2015. The evidence suggests that unemployment and spread of sexually transmitted infections (STIs) are not the root cause of why men are more likely to commit suicide. It is also clear that national revenue and the reluctance of men to psychiatric intervention are the causes of the higher suicide rate. However, the study revealed that openness to psychiatric intervention would significantly affect the male to female suicide ratio. An increasing openness to psychiatric intervention would decrease the suicide rate of men.

Risk of Suicide Among Patients with Benign Prostatic Hyperplasia in South Korea: A Nationwide Retrospective Cohort Study

Background: Benign prostatic hyperplasia is a commonly diagnosed disease in elderly men, but it is a serious threat to quality of life and causes depression. Our study aims to evaluate the risk of suicide death among patients with benign prostatic hyperplasia relative to a control group comprising individuals without benign prostatic hyperplasia. Methods: We used the Korean National Health Insurance Service-National Sample Cohort from 2006 to 2015 comprising of 193,785 Korean adults ≥40 years old, and followed-up for suicide death during the 8.7 years period. Cox-proportional hazard model was used to estimate hazard ratios for suicide among patients with benign prostatic hyperplasia. Outcomes: From 2006 to 2010, a total of 32,215 people were newly diagnosed with benign prostatic hyperplasia. The suicide rate of people without benign prostatic hyperplasia was 61.6 per 100,000 person-years, whereas that of patients with benign prostatic hyperplasia was 97.3 per 100,000 person-years, 1.58 times higher than the control group (p<0.01). After adjusting for covariates, the hazard ratio for suicide among patients with benign prostatic hyperplasia was 1.47 (95% C.I. =1.21 to 1.78; p<0.01) compared to people without benign prostatic hyperplasia. Interpretation: Our study shows that men with benign prostatic hyperplasia had a higher risk of suicide compared to men without benign prostatic hyperplasia in South Korea. This study suggests that care for mental disorders as well as treatment for depressive symptoms might be necessary for patients with benign prostatic hyperplasia. Funding Statement: This study was supported by grant of the National Center for Mental Health (2018-08). Declaration of Interests: On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of National Center for Mental Health (IRB No.116271-2018-32). Our study protocol was exempted from review because it was not a clinical trial, which required contacting the patients, and NHIS-NSC database was anonymized to prevent identification of individuals.

Army May Be Missing Risk Factors Beyond MH for Attempted Suicide Among Soldiers

Suicide attempts among U.S. Army soldiers are not always preceded by a diagnosis of mental illness.

Gender inequality and suicide gender ratios in the world

BackgroundTo assess whether gender inequality determines the patterns of suicide gender ratios. MethodsUsing suicide data obtained from the World Health Organization Statistical Information System, 2012, suicide gender ratios were calculated and a world map of the ratios constructed. Forest plots were utilized to assess whether gender inequality (indicated by the Gender Inequality Index [“GII”] and male to female sex ratios at birth) moderated the worldwide patterns of suicide gender ratios. Regression analyses were then performed to estimate the extent to which gender inequality affects suicide gender ratios before and after controlling for human development level (“HDI”). ResultsGradient relationships of suicide gender ratios across 3 tertiles of GII were observed (ratios = 2.03, 2.54, 3.51, respectively for high, moderate and low GII, P = 0.03). High sex ratio at birth was significantly associated with lower suicide gender ratio (ratio = 1.64 vs. 2.75, P = 0.00). Regression analyses showed that highest tertile of GII and high sex ratios at birth were significantly associated with lower suicide gender ratios (P = 0.00 and P = 0.00, respectively). When the level of human development level was controlled, high sex ratio at birth remained to be a significant determinant of suicide gender ratios (P = 0.00), whereas the significance of GII disappeared (P = 0.19). LimitationsThe cross-sectional data do not allow for causal inferences. ConclusionsMale to female suicide ratios were higher in countries with more egalitarian gender norms. Strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.

The influence of undetermined deaths on suicides in Shanghai, China.

In global forensic practice, some suicides were misclassified as undetermined deaths, leading to suicide underreporting. In this study, we aimed to explore the influence of undetermined deaths on suicides in Shanghai, China. The police records on suicide verdicts and undetermined deaths in Pudong, Shanghai, from 2004 to 2016 were used. In this study, undetermined deaths have been classified into three levels of suicide possibilities namely, probable, possible, and highly unlikely. Probable suicides were presumed as misclassified suicides. Poisson regression was used to calculate the rate ratio ("RR") of probable suicides compared to suicide verdicts. Poisson regression was also used to calculate the annual percentage change ("APC") of the original suicide rates (crude suicide rates based on the suicide verdicts) and adjusted suicide rates (crude suicide rates based on the suicide verdicts and probable suicides). Among the 1,318 underdetermine deaths, 560 (42.5%) were classified as probable suicides. The overall RR was 0.23 (95% CI 0.21-0.26): 0.15 (0.13-0.17) for the locals' RR and 0.22 (0.19-0.26) for the migrants' RR. The APCs of the original and adjusted suicide rates were - 2.0 (-3.1 to -0.9) and - 2.9 (-3.8 to -2.0), respectively, for the overall population. The number of suicides could be 23% higher than the reported cases. Suicides were more likely to be underreported in migrants than in the locals. Thus, it is important to improve suicide monitoring and the surveillance systems in China.

Incidence of Suicide in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

Background and AimsPatients with inflammatory bowel disease (IBD) have higher incidence of psychosocial disorders, including depression. As suicide is the most severe manifestation of depression, we sought to identify if patients with IBD have a higher incidence of suicide through a systematic review and meta-analysis.MethodsSystematic literature searches for articles using EMBASE and MEDLINE using Ovid were conducted to identify studies investigating suicide in IBD. Reference harvesting of the bibliographies of key articles was also performed. We included studies reporting expected number of death or standardized mortality ratio (SMR) for suicide in IBD. Meta-analysis for each IBD condition (Crohn’s disease [CD] and ulcerative colitis [UC]) was conducted separately, as well as combined.ResultsSeven cohort studies were identified through our search strategy and included in our systematic review and meta-analysis. In our analysis, the SMR for suicide in patients with IBD for all studies included was 1.20 (95% CI, 0.94–1.54). The overall pooled SMR for CD and UC were 1.36 (95% CI, 0.98–1.88) and 1.16 (95% CI, 0.8–1.69) respectively.ConclusionsPatients with Crohn’s disease and ulcerative colitis may have an increased risk of suicide. These results highlight the importance physicians must place on ensuring the mental health of patients with IBD is both assessed and treated appropriately.

Guns and Suicides

ABSTRACTThere is a consensus in the literature that the ratio of suicides committed with guns to total suicides is the best indirect measure of gun ownership. However, such a proxy is not accurate for any locality with low population density in view that suicides are rare events. To circumvent this issue, we exploit the socioeconomic characteristics of the suicide victims in order to come up with a novel proxy for gun ownership. We assess our indicator using suicide micro-data from the Brazilian Ministry of Health between 2000 and 2010.

A social change perspective on injury prevention in China

IntroductionChina has undergone massive social change over the past four decades. Since national estimates became available in 1987, the overall fatal injury rate has decreased. This paper investigates targeted interventions...

Risk of suicide following an alcohol-related emergency hospital admission: An electronic cohort study of 2.8 million people.

ObjectiveAlcohol misuse is a well-known risk factor for suicide however, the relationship between alcohol-related hospital admission and subsequent risk of death from suicide is unknown. We aimed to determine the risk of death from suicide following emergency admission to hospital with an alcohol-related cause.MethodsWe established an electronic cohort study of all 2,803,457 residents of Wales, UK, aged from 10 to under 100 years on 1 January 2006 with six years’ follow-up. The outcome event was death from suicide defined as intentional self-harm (ICD-10 X60-84) or undetermined intent (Y10-34). The main exposure was an alcohol-related admission defined as a ‘wholly attributable’ ICD-10 alcohol code in the admission record. Admissions were coded for the presence or absence of co-existing psychiatric morbidity. The analysis was by Cox regression with adjustments for confounding variables within the dataset.ResultsDuring the study follow-up period, there were 15,546,355 person years at risk with 28,425 alcohol-related emergency admissions and 1562 suicides. 125 suicides followed an admission (144.6 per 100,000 person years), of which 11 (9%) occurred within 4 weeks of discharge. The overall adjusted hazard ratio (HR) for suicide following admission was 26.8 (95% confidence interval (CI) 18.8 to 38.3), in men HR 9.83 (95% CI 7.91 to 12.2) and women HR 28.5 (95% CI 19.9 to 41.0). The risk of suicide remained substantial in subjects without known co-existing psychiatric morbidity: HR men 8.11 (95% CI 6.30 to 10.4) and women HR 24.0 (95% CI 15.5 to 37.3). The analysis was limited by the absence in datasets of potentially important confounding variables and the lack of information on alcohol-related harm and psychiatric morbidity in subjects not admitted to hospital.ConclusionEmergency alcohol-related hospital admission is associated with an increased risk of suicide. Identifying individuals in hospital provides an opportunity for psychosocial assessment and suicide prevention of a targeted at-risk group before their discharge to the community.

Increasing Male Preponderance in Suicide Coinciding With a Reduction by Half in Total Suicides in the Danish Population Should Raise Awareness of Male Depression

Increasing Male Preponderance in Suicide Coinciding With a Reduction by Half in Total Suicides in the Danish Population Should Raise Awareness of Male Depression

Suicide risk among cancer survivors: Head and neck versus other cancers.

146 Background: While head and neck cancer (HNC) only accounts for 4% of new cancer cases in the United States, incidence of HNC-associated suicide may be significantly higher due to quality of life issues associated with HNC survivorship. This study estimated incidence of HNC-associated suicide versus other common cancers, and quantified suicide rate among HNC survivors compared with non-HNC. Methods: We queried the Surveillance, Epidemiology and End Results 18 database from 2000-2014 for all cancer deaths confirmed as suicide. Mortality rates from suicide was estimated for the 21 most common cancers in the United States, including HNC. Negative binomial regression estimated mortality rate ratios (MRRs) and 95% confidence intervals (CIs), between HNC and the other 20 other cancers combined, and as individual sites. Models were stratified by sex (when applicable), controlling for race, marital status, age, year and stage of diagnosis. Results: There were 4,769 suicides observed among 4,613,123 cancer survivors from 2000-2014, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Combined, all other cancers had a 45% decreased suicide ratio compared to HNC for both males (MRR = 0.55, 95% CI 0.48, 0.64) and females (MRR = 0.55, 95% CI 0.37, 0.81). For specific cancer sites, only pancreatic cancer had a higher mortality rate due to suicide than HNC (86.4 suicides per 100,000 person-years, versus 63.4 suicides per 100,000 person-years). Stratified by gender, only male pancreatic cancer survivors had a significantly higher suicide MRR compared with HNC (MRR = 1.54, 95% CI 1.23, 1.90). For females, all cancer sites (including pancreas) had either significantly or insignificantly lower suicide MRR compared with HNC. Conclusions: Risk of suicide is significantly higher among HNC survivors compared to all other cancers, except pancreatic cancer. Our findings confirm that HNC survivors are prime candidates for lifelong psychosocial surveillance.

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

Risk of suicide within 1 year of cancer diagnosis.

The association of the risk of suicide with cancer at different time points after a new cancer diagnosis is unclear. This study explored the suicide hazard at different time points after a first cancer diagnosis during the 1-year period before suicide. This case-crossover study included 2,907 suicide cases from 2002 to 2012 in Taiwan and compared the odds of suicide risk at different time points during one year after any cancer diagnosis with self-matched periods. The 13th month preceding the suicide date was used as the control period, and the hazard period was the duration from the 1st to 12th month in the conditional logistic regression for case-crossover comparisons. Among major groups of cancers, group of lip, oral cavity and pharynx cancers tended to have higher risk of suicide than other groups of cancers. The first month of cancer diagnosis was associated with the highest risk of suicide compared with the 13th month before suicide. The odds ratio (OR) of suicide were significantly in the first six months after cancer diagnosis but declined afterwards. For example, the adjusted OR was 3.47 [95% confidence interval (CI) = 2.60-4.62] in the first month and 1.53 (95% CI = 1.11-2.12) in the sixth month following cancer diagnosis. These findings provide clinicians with a vital reference period during which sufficient support and necessary referral to mental health support should be provided to reduce the risk of suicide among patients with newly diagnosed cancer morbidity.

Gender differences in suicide in Serbia within the period 2011-2015

Background/Aim. The World Health Organisation (WHO) estrimates that approximately 1,000,000 people die by suicide every year. The aim of this study was to examine the gender differences in cases of committed suicides, including suicide rates, socio-demographic factors and methods of suicide in Serbia within the period 2011?2015. This investigation is continuing the previous investigation from the period 2006?2010. Methods. Data were obtained from the Statistical Office of the Republic of Serbia. Their classification related to the suicide method was carried out on the basis of International Classification of Diseases-Tenth Revions- Clinical Modification (ICD-X-CM) (WHO 1992). Statistical analysis was done by using the crude number of committed suicide. Results. Within the period 2011?2015, the total number of suicides in Serbia was 5,897, of which 74.56% were males and 25.44% females (male to female suicide ratio was 2.93). Annual suicide rate (per 100,000) showed constantly decreased from 2011 to 2015, and in 2015 it was 15. Male/female suicide ratio was the highest among adolescents and decreased with age. The suicide was the most often committed by married males (47.6%) and widowed females (38.86%) with completed high school, retired, Serbs. About a quarter (23.38%) suicide committers were older than 75 years, and 39.39% were older than 65 years. The most common suicide method males (64.63%) and females (59.00%) used was hanging, strangulation and suffocation. The second most common method males used was by firearm (18.96%) and females by poisoning (16.73%). Conclusions. Suicide Prevention Programme in Serbia should be primarily oriented towards two age groups at highest risk to commit suicide, towards the adolescents whose suicide was on the rise and towards the elderly male population, less ready to refer to the doctors for help because of problems related to their mental health. With the aim to suicide prevention, doctors should become familiar with community, state and national resources that are concerned with youth and elderly populations, including mental health institutions, family and crisis intervention centers.

The disease burden of suicide in Ecuador, a 15\xa0years\u2019 geodemographic cross-sectional study (2001\u20132015)

BackgroundSuicide affects people from different backgrounds, ethnical groups, socio-economic status and geographical locations. In Latin America, suicide reports arescarce, specially in Andean countries. In Ecuador, very few reports have partially described this phenomenon, nonetheless, estimation of the burden of disease (BoD) hasnever been reported in the country.MethodsA country-wide comparison was performed using the Ministry of Public Health’s national databases of overall mortality, Hospital Discharges Database, and the Population Census of the National Institute of Census and Statistics (INEC). The study variables analyzed were age, geographical distribution to provincial level, sex, means of suicide, educational attainment, marital status and mortality. Linear Regression and relative Risk analysis were used to predict outcome and the likelihood that suicide occur among study variables.ResultsIn the last 15 years, 13,024 suicides were officially reported. Men were 3 times more likely than women to die by suicide. The overall age-adjusted suicide ratio in Ecuador corresponds to 7.1 per 100,000 per year. The sex-specific rates were 5.3 in women and 13.2 in men. The primary mean of suicide was hanging X70 (51.1%), followed by self-poisoning X68-X69 (35.2%) and firearms X72-X74 (7.6%). Provinces located at higher altitude reported higher rates than those located at sea level (9 per 100,000 vs 4.5 per 100.000). The total economic loss due to suicide was estimated to be $852.6 million during the 15 years’ analysis.ConclusionsThis is the first geodemographic study exploring the complete burden of suicide in Ecuador and one of the very few in Latin-America. In the last 15 years of available data, Ecuador ranks above the regional average with an adjusted suicide rate of 7.1 per 100,000 inhabitants. An important finding is that Suicide affects rather younger populations, adding more than 10,000 years of premature years of life lost (YYL) between 2001 and 2015, becoming the first and fourth leading cause of death among adolescent women and men respectively.Suicide affects people from different backgrounds, socioeconomic status and educational attainment. The mean of suicide changed over time showing that gun and pesticides related deaths decreased significantly since 2001, while hanging and suffocation increased in more than 50%.

Factors associated with post-stroke suicidal death

Background and purposeThe aim of this study was to estimate the relative risk of suicidal death compared to the general population and to identify risk factors for suicidal death among stroke patients. MethodsOur sample consisted of 7175 patients who were diagnosed with stroke and admitted at Asan Medical Center from January 2005 to December 2012. Information on suicidal death was obtained from the database of the Korean National Statistical Office. The standardized mortality ratio (SMR) for post-stroke suicide was estimated. Additionally, we conducted a 1:6 case-control study using patients who did not commit suicide. ResultsThirty patients committed suicidal death, with the mean time interval between hospital admission and suicide being 1.9 ± 1.8 years. The SMR for suicide was 2.14 (95% confidence interval [CI], 1.44–3.05). Case-control analysis revealed that diabetes mellitus, depression, and large ischemic lesions in the subcortex and brainstem were significantly associated with suicidal death. ConclusionsThe risk of suicidal death is approximately 2 times higher than that in the general population. Depression, diabetes, and large lesions in specific locations should be considered in the implementation of suicide prevention strategies in stroke patients.