Suicides In Finland Research Articles

Deliberate fatal crashes involving a motor vehicle and a cyclist or pedestrian

IntroductionDeliberate crashes are caused by road users engaging in insurance fraud, attempting suicide, or “punishing” other road users. In this study, we investigated deliberate crashes that resulted in the deaths of “vulnerable” road users (cyclists and pedestrians). MethodsWe used in-depth road crash investigation data from the Finnish Crash Data Institute and court decisions for a selected number of cases in which the deceased had not been the main originator of the crash. ResultsIn 1997–2018, 96 pedestrians and five cyclists died in 101 deliberately caused crashes involving a motor vehicle. The majority of these crashes were caused by suicides (94/96 pedestrian and 3/5 cyclist crashes). Most of suicide crashes (79%) involved a heavy vehicle. Eighty percent of the victims were male. Previous suicidal thoughts and attempts, and a history of mental disorders/illness was prevalent around two thirds of the originators of the crashes. Four cases were caused by motor vehicle drivers. According to court rulings, the drivers in two of these cases were convicted of manslaughter. ConclusionsWe provide some possible reasons for this relatively high number of road suicides in Finland and discuss the legal implications of deliberately hitting pedestrians or cyclists with a motor vehicle.

Calculation of Costs Related to Death by Suicide in Finland

There are relatively few calculations of the costs related to suicides. The aim was to produce a monetary estimate of the costs incurred as a result of suicides. The costs were divided into three categories: (1) loss of labor input, (2) costs directly following a suicide, and (3) costs associated with family members. In our two sample cases, the costs related to suicides were from EUR 309,020 to EUR 456,279. By putting the monetary costs of suicide prevention intervention and the calculation of costs related to a death by suicide side by side, this study may help when allocating funding for effective intervention.

Serotonergic 5HTTLPR/rs25531 s‐allele homozygosity associates with violent suicides in male citalopram users

Depressive disorders are involved as a background factor in over 50% of suicide cases. The most widely used antidepressants today are serotonin selective reuptake inhibitors (SSRIs). However, not all users benefit from SSRI medication. Although the overall number of suicides in Finland have decreased notably during the last decade, the annual rate is still relatively high, particularly in male population. In this study, we tested the hypothesis that the genetic variants associated with decreased citalopram efficiency, 5HTTLPR/rs25531, and increased impulsive behavior, MAOA-uVNTR and HTR2B Q20*, are more frequent among citalopram users committing suicide than among the citalopram users in general. Also the effect of alcohol was evaluated. The study population comprised 349 suicide victims (184 males and 165 females). Based on the suicide method used, cases were divided into two groups; violent (88 males and 49 females) and non-violent (96 males and 116 females). The control group (284; 159 males and 125 females) consisted of citalopram users who died of causes other than suicide. We found that male citalopram users with low functioning s/s genotype of 5HTTLPR/rs25531 were in increased risk to commit violent suicide (OR 2.50, 95%CI 1.15-5.42, p = 0.020). Surprisingly, high blood alcohol concentration was observed to be a risk factor only in non-violent suicides (both males and females), but not in violent ones. No association between suicides and MAOA-uVNTR and HTR2B Q20*, which have been previously connected to violent and impulsive behavior, was detected.

The Unjustified Emotions: Child Suicide in Finnish Psychiatry from the 1930s until the 1970s

This article examines the psychiatric discourse on child suicide in Finland from the 1930s until the 1970s. The studies on suicides committed by children reflect a clear change in the psychiatric notion of normalcy as well as in the predominant social attitudes of the era. The changes in the conception of child suicide, it is argued, were due to transformations in how the emotional lives of children have been understood in the society in general. Child psychiatry has, therefore, played a dual role as the producer of knowledge and as the mirror reflecting the changing social understanding of a complex and taboo subject.

Economic hardship and suicide mortality in Finland, 1875–2010

We investigate the determinants of suicide in Finland using annual data for consumption and suicides from 1860 to 2010. Instead of using some ad hoc measures of cyclical movements of the economy, we build our analysis on a more solid economic theory. A key feature is the habit persistence in preferences, which provides a way to measure individual well-being and predict suicide. We estimate time series of habit levels and develop an indicator (the hardship index) to describe the economic hardship of consumers. The higher the level of the index, the worse off consumers are. As a rational response to such a bad situation, some consumers might commit suicide. We employ the autoregressive distributed lags cointegration method and find that our index works well in explaining the long-term behavior of people committing suicide in Finland.

Autopsy rate in suicide is low among elderly in Denmark compared with Finland

National differences in the legislation on cause and manner of death investigation are reflected in a high autopsy rate in suicides in Finland and a low corresponding rate in Denmark. The consequences for mortality statistics of these different investigation practices on deaths classified as suicides in Denmark and Finland, respectively, are not known in detail.The aim of this article was to analyse autopsy rates in deaths classified as suicides, and to identify any differences in investigation practices in deaths with a comparable cause of death, but classified as unnatural deaths other than suicide.Data from the mortality registries were summarised for the years 2000, 2005 and 2010. Autopsy rates (total, forensic and medical) were analysed with regard to deaths classified as suicide, and they were compared for three age groups (1–50 years, 51–70 years and ≥71 years) and for causes of death. Deaths classified as suicide were compared with other unnatural classifications, and comparable causes of death were coded into six subgroups: poisonings, suffocations/strangulations, firearm discharges, drowning/submersions, explosions/flames and other/unspecified causes.The total autopsy rate for suicides was 99.8% in Finland and 13.2% in Denmark. Almost all of these autopsies were conducted as forensic autopsies. In the age group ≥71 years, Danish suicides outnumbered Finnish suicides (410 versus 283). The total autopsy rate was lower in the more senior age group in Denmark (19.5%, 9.9%, 5.6%), whereas it was consistently high in Finland (99.8%, 99.9%, 99.6%). Among Danish deaths due to poisonings, the autopsy rate was 89.5% when these were classified as accidents, but only 20.7% for cases classified as suicides. The number of deaths in the two Danish subgroups was comparable (550 versus 553).In Denmark, the decision regarding the need, if any, for a forensic autopsy is made during the external forensic examination of the body. Our study showed that the limited use of forensic autopsy to confirm the cause of death in deaths classified as suicides raises doubts about the accuracy of the Danish suicide mortality statistics. Our finding is emphasised by those cases in which the cause of death was registered as intentional self-poisoning. The high number of suicides among the elderly in Denmark is striking and begs further investigation and research. Overall, our data from Finland and Denmark reveal striking differences between the two countries and warrant further comparative studies on the subject in other countries.

EPA-1476 – Suicide prevention project in finland: focus on outpatient care

The suicide rate has been traditionally high compared to countries of the European Union. The rate increased during decades after second world war until the early 1990's. Moreover, the suicide rate has followed closely the alcohol consumption rate. A national suicide prevention project was carried out in the late 1980's, which had the intent to increase access to low-threshold services and specialized psychiatric care. Physicians and psychiatrists were educated in the recognition of depression at a time when novel antidepressants were introduced and secondary level services were deinstitutionalized. Aims The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies. Results The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospitalbased services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care. Conclusion In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

Temperature-associated suicide mortality: contrasting roles of climatic warming and the suicide prevention program in Finland

Suicide is a notable cause of death worldwide, and while suicidal behavior appears to be associated with variations in temperature, no estimations are available of climate change impacts on suicide rates. The study aims to evaluate the influence of temperature on suicide mortality, especially on multi-decadal and longer time scales, that is, at scales on which the ongoing warming distinctly operates and is correspondingly appropriate for the current policy responses to warming climate. Our results are based on an extraordinarily long record of deaths from suicide in Finland from 1751 to 2008, and a similarly long climatic record of ambient temperatures correlative of environmental change in the study region. We show that temperature variability explains more than 60 % of the total suicide variance up until the initiation of a national suicide prevention program. Despite ongoing warming, suicide rates have declined since the initiation of the program. By understanding the complexity of suicidal behavior as a response to ambient warming and the observed effects of interventions, our results underline the pressing need for a network of prevention programs to battle against temperature-mediated health hazards.

2781 – Suicide prevention in finland: advances and perspectives

The suicide rate has been traditionally high compared to countries of the European Union. The rate increased during decades after second world war until the early 1990's. Moreover, the suicide rate has followed closely the alcohol consumption rate. A national suicide prevention project was carried out in the late 1980's, which had the intent to increase access to low-threshold services and specialized psychiatric care. Physicians and psychiatrists were educated in the recognition of depression at a time when novel antidepressants were introduced and secondary level services were deinstitutionalized. The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies. The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospital-based services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care. In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

Relationship between daylength and suicide in Finland

BackgroundMany previous studies have documented seasonal variation in suicides globally. We re-assessed the seasonal variation of suicides in Finland and tried to relate it to the seasonal variation in daylength and ambient temperature and in the discrepancy between local time and solar time.MethodsThe daily data of all suicides from 1969 to 2003 in Finland (N = 43,393) were available. The calendar year was divided into twelve periods according to the length of daylight and the routinely changing time difference between sun time and official time. The daily mean of suicide mortality was calculated for each of these periods and the 95% confidence intervals of the daily means were used to evaluate the statistical significance of the means. In addition, daily changes in sunshine hours and mean temperature were compared to the daily means of suicide mortality in two locations during these afore mentioned periods.ResultsA significant peak of the daily mean value of suicide mortality occurred in Finland between May 15th and July 25th, a period that lies symmetrically around the solstice. Concerning the suicide mortality among men in the northern location (Oulu), the peak was postponed as compared with the southern location (Helsinki). The daily variation in temperature or in sunshine did not have significant association with suicide mortality in these two locations.ConclusionsThe period with the longest length of the day associated with the increased suicide mortality. Furthermore, since the peak of suicide mortality seems to manifest later during the year in the north, some other physical or biological signals, besides the variation in daylight, may be involved. In order to have novel means for suicide prevention, the assessment of susceptibility to the circadian misalignment might help.

Driver suicides in Finland - are they different in northern and southern Finland?

Objectives. This study focused on driver suicides in Finland. The first aim was to find out what the prevalence of these suicides was during the years 1974–2006. The second aim was to find out whether there were differences between northern and southern Finland in regards to the number of cases and the backgrounds of the drivers who committed suicide this way.Study design. All case reports of fatal motor vehicle accidents from the years 2005–2006 were investigated (n=528). Results were compared to the years previously investigated: 1974–1975, 1984–1985, 1987–1988, 1991–1992, 1993–1994 and 1997–1998 (n=3482).Methods. As driver suicides were classified, only those crashes in which the driver’s intention had notably influenced the progress of the crash and the driver’s background information clearly supported suicide. Driver suicides in northern and southern Finland were compared. Driver suicides were related to both the number of fatal motor vehicle accidents and the number of inhabitants.Results. Driver suicides increased during the period under study. However, both the number and the proportion of driver suicides have been quite constant since the beginning of the 1990s, averaging 20 per year, which is 8% of all fatal motor vehicle accidents in Finland. There were no differences in northern and southern Finland regarding driver suicides.Conclusions. Driver suicides represent a small proportion (2%) of all suicides committed in Finland every year. However, the proportion of driver suicides of all fatal motor vehicle accidents is greater, around 8%–9%. As a majority of driver suicides are collisions, they affect an even larger group of people. Possible preventive measures are discussed.

The Effects of Education, Social Class and Income on Non-alcohol- and Alcohol-Associated Suicide Mortality: A Register-based Study of Finnish Men Aged 25–64

This study aimed to analyse the effects of different socioeconomic indicators on non-alcohol-associated and alcohol-associated suicide in Finland. The data used comprised the 1990 census records for men who were 25–64-years old linked to the death register for 1991–2001. Poisson regression was used to calculate the adjusted relative mortality rates. There were 6,452 suicides among the study population, and in 42% of them alcohol intoxication was a contributory cause. Education, occupation-based social class and household income were inversely and strongly related to suicide regardless of the link with alcohol. For non-alcohol-associated suicide, the effect of education was largely mediated by social class and income, the effect of social class was partly explained by education and partly mediated by income, and the effect of income was rather small after adjustment for the other two indicators. When alcohol was involved, social class mediated a large part of educational effect, but a strong association also remained. Respectively, education explained a large proportion of the social class differences. Income had a minor effect. Adjustment for employment status explained some of the income differences, but living arrangements had little effect. The findings imply that low social class is associated with increased suicide risk regardless of employment status, and that the roots of socioeconomic differences in alcohol-associated suicide lie in early adulthood when education and health behavioural patterns are set. This casts some doubt on claims that current material factors are the main drivers of socioeconomic differences in suicide.

Time patterns and seasonal mismatch in suicide.

Physical time-givers may have a modifying effect on the time patterns of death from suicide. Data on a total of 1397 suicides in Finland over a year were collected using the method of psychological autopsy. We linked versatile information on each individual to meteorological data adjusted for local weather conditions, and to the universal astronomic data. The number of suicides with seasonal mismatch was greater than the expected in the northernmost region of the country (P = 0.03). The northern location was the most significant predictor of such suicides (P = 0.001). They were associated with the changes in ambient temperature during the preceding day (P < 0.00001), the changes to colder preceding suicides in the spring. Our findings show that mismatch between the changes in ambient temperature and those in the length of day may precede death from suicide in some individuals.

Homicide Followed by Suicide in Finland: Trend and Social Locus

In the early 1960s, 15% of Finnish homicide offenders committed suicide after the crime. In 1998–2000, this ratio was 6%. The downward trend was due to the increase in non-suicidal homicide, as well as to a substantial decrease in the general homicide-suicide rate. Over the time span, the rate of suicidal homicide offenders per 100,000 population was halved. The decrease took place in the two most significant homicide-suicide types (that is, those of intimate-partner homicides and parent-child killings) and, within these crime types, in crimes committed by men. The present article describes the prevalence and trend of homicide-suicide in Finland, and examines the socio-economic correlates of this phenomenon. The findings indicate that the percentage and the rate of homicide-suicide have been consistently highest among middle classes and lowest among the unemployed and working classes. Victim-offender relationship, stressful life events, and alcohol consumption are discussed as explanations for this stable social difference.

Seasonal variation in specific methods of suicide: a national register study of 20 234 Finnish people

Background: Previous studies have suggested differences in seasonal variation of violent and non-violent suicides, but seasonal distribution of the specific methods of suicide is less clear. Method: We investigated the seasonal distribution of the specific suicide methods for both genders during a 16-year period. The seasonal effect was explored by monthly ratio statistics from the large population-based data including all suicides in Finland during years 1980–1995 ( n=20 234). Results: Hanging peaked in spring among both genders. In summer, the significant peaks were occurred in suicides by drowning, jumping and gassing among males. The bimodality in female suicides with autumn peaks was explained by poisoning and drowning. Traffic suicides showed substantial winter-troughs for both genders. Conclusions: The results suggested that specific violent and nonviolent methods of suicides grouped into their traditional clusters on the basis of their seasonality, except suicides by gassing and shooting. The seasonal distribution in specific suicide methods should take into account in suicide prevention at clinical work and also it should be considered while determining which methods of suicides are regarded as violent or non-violent methods in research.

Elderly Suicide in Finland

Suicide mortality among the elderly is high in most Western countries. We investigated the characteristics of suicide victims 65 years or older in a nationwide psychological autopsy study, the research phase of the National Suicide Prevention Project in Finland. This study population included all completed suicides (N = 1,397, of whom 211 were 65 years or older) that occurred in Finland during a 12-month research period in 1987-1988. The elderly suicide victims were found to have used violent suicide methods more often than the young. Although almost 70% of the elderly persons who had committed suicide had been in contact with health care services during the month before their death, their suicidal intentions were rarely communicated in these contacts. They had been referred to psychiatric services less often than the young, and only 8% had received adequate antidepressive medication. The fact that most elderly suicides have contact with health care services during their final month suggests a potential for suicide prevention. However, the major obstacle to this is the poor recognition of mental disorders and suicidal ideation among the elderly.

Life events and completed suicide in schizophrenia: a comparison of suicide victims with and without schizophrenia.

Adverse life events are an established risk factor in completed suicide. However, few studies have examined life events and suicide in schizophrenia. We investigated and compared schizophrenia suicide victims and age- and sex-matched victims without schizophrenia as part of a psychological autopsy study of all suicides in Finland over a 12-month period. Recent life events were examined retrospectively by interviewing next of kin using a structured life event questionnaire. Overall, nearly half (46%) the schizophrenia subjects had had adverse life events before suicide, significantly less than the nonschizophrenia subjects (83%). In both groups, however, suicide was preceded by life events independent of the victims' own behavior, such as death of a close person or illness in the family. Life events overall were more common among schizophrenia outpatients (52%) than inpatients (22%), and the association of life events with suicide was clearest among a subgroup of outpatients in residual phase who had used neuroleptic medication regularly. Overall, the prevalence of recent adverse life events varied between clinical subgroups of victims with schizophrenia, which may have implications for suicide prevention.

Suicide attempts preceding completed suicide.

This study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide. The lifetime history of suicide attempts and the methods the victims (n = 1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987-1988. Overall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included). Most male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

Prison suicide in Finland, 1969–1992

Background. All prisoners' suicides in Finland during 1969–1992 ( n = 184) were studied. Method. The data were collected from official documents. Results. Of all prisoners' deaths, 47% were suicides. The rate of suicide among male prisoners was three-fold compared to the normal adult Finnish male population. More than half of those committing suicide had a psychiatric disturbance and one half of them had visited the prison health services because of a psychiatric problem not more than one week before the suicide. Almost one third of the suicides were committed in isolation rooms. Contrary to the findings of many previous studies, there was no concentration of suicides at weekends, on religious holidays, in different seasons nor at the beginning of the confinement. Conclusions. The most important finding of this study was the common use of health care facilities in the prison just before the suicide. It is important to try to develop the means to recognize suicidal ideation among all prisoners seeking psychiatric care. The surveillance of prisoners in isolation cells needs to tighten up and should probably be continuous.

Suicide among Military Conscripts in Finland: A Psychological Autopsy Study

This study describes suicides during compulsory military service and compares them with other young male suicides as part of a nationwide psychological autopsy study of all suicides in Finland during a single year. The victims' relatives and attending health care personnel were interviewed, and data from records were collected. Five of the seven conscript suicides had a depressive syndrome, often of short duration. Two victims previously had suicidal thoughts or attempted suicide. The most common suicide method was with firearms. Compared with other young male suicides, physical illness in conjunction with a psychiatric diagnosis was less common in the conscript victims. Civilian male suicides tended to have more substance abuse and more severe psychological impairment. They also committed suicide under the influence of alcohol more often than conscripts. Interpersonal separation was more often the precipitating event of the suicide among the conscripts than among the other suicides. Conscripts should be encouraged to utilize health and social services when they have psychosocial problems or even minor psychiatric symptoms.