Variation In Suicide Research Articles

Variation in Suicide Occurrence by Day and during Major American Holidays

BackgroundDue to temporal variations in completed suicides, it has been suggested that impulsivity and environmental factors may influence suicide. Study ObjectiveOur intent was to determine if particular days of the week, seasons, or holidays were associated with increased attempted and completed suicides by poisoning. MethodsAll calls recorded in the National Poison Database System coded as “suspected suicide” from 2006 through 2010 were included. Exposures were evaluated by day, season, and holidays, and compared to control dates. ResultsThere were 1,065,067 exposures (63% female) related to suicide attempts, with completions in 0.4% of cases. Sundays and Mondays for adults, and Mondays and Tuesdays for age < 19 years were the most common. Spring and fall had higher numbers of exposures than summer and winter. New Year's Day had a higher number of exposures, whereas Independence Day, Thanksgiving, and Christmas had fewer exposures. ConclusionsThe beginning of the week, spring and fall, and New Year's Day were associated with higher numbers of ingestions with suicidal intent. This has implications for clinicians advising potential victims and providing emergency care for these patients.

Seasonality of suicide deaths in Serbia, 1990-2012

Background: In the period from 1990 to 2012, there were 32,855 suicides registered in Serbia, i.e. an average of 1428 deaths per year (18.9 per 100.000 inhabitants). The suicides were the most frequent in the early 1990s, less frequent during the 2000s, and least frequent in the last three years of the observed period (2010-2012 - an average of 1237 suicides per year). Objective: The goal of this paper is to evaluate the seasonal variations of suicides in Serbia in the period of 1990-2012, their changes, as well as the accordance with findings from other countries. Method: In the paper are used "classical" statistical methods of evaluating cyclical variations (?2-test, Edwards' test) as well as some frequently used newer methods (e.g. the peak-low ratio). It also introduces a new indicator of the intensity of monthly variations in suicides (the magnitude of trimester variations of /12/ moving consecutive months index - the MtMV index). Seasonality of suicides is also observed by sex. Results: The results of the research of seasonality confirm that certain cyclical variations in mortality due to suicide are also present in Serbia. Observed by season, suicides are most frequent in spring and summer and less in winter. The cyclical nature was also clearly confirmed by month. Suicides are most frequent in "warm" months (April-August) and far less frequent in "cold" months (December-February). By month, suicides are most frequent in May, while the maximal average number of suicides per day was calculated for June (21 % higher than the average for 1990-2012). December is singled out as the month with the lowest number as well as lowest daily average of suicides (25 % lower than the average). Conclusion: The cyclical nature of suicides is clearly notable during the entire observed period and no significant fluctuations or decrease in the intensity of the variation were observed. Regardless of the method of analysis, the resulting conclusions are identical regarding the cyclical nature of the variations and the temporal characteristics of suicides in Serbia at the end of the 20th and the beginning of the 21st century. At the aggregate level there are no significant differences in seasonal variations of suicides committed by men and women. Changes also developed in parallel and in the same direction for both sexes.

EPA-0245 - The spatial pattern of suicide in belarus: does alcohol matter?

Introduction Suicide is one of the main causes of premature mortality in Belarus, bringing considerable loss of human lives. The alarming increase in the occurrence of suicide in Belarus in 1990s has resulted in the country having one of the highest suicide rates in the world. Epidemiological analysis has showed that rates of suicide vary noticeably between the regions in Belarus with the regular spatial pattern in suicides distribution. Objectives The aim of this study was to consider the effect of regional alcohol consumption as a factor responsible for suicides regional variations. Methods The cross-sectional time series analysis of suicides and alcohol psychoses (as a proxy for alcohol consumption) rates by the regions of Belarus during the period 1990-2010 was performed. Results The analysis indicates that the regional variations of suicides and alcohol psychoses incidence rates have a similar spatial regularity, which means that the regions with a high suicide rate also have a high alcohol psychoses incidence rate. The effects of alcohol psychoses incidence (as a proxy for alcohol consumption) on suicide rates were generally positive and significant; only Minsk city obtained a non-significant estimate. The largest estimates were found in Minsk region (0.68) and in Mahiliou region (0.55). The estimates for Brest and Vitebsk regions were somewhat lower (0.41). Conclusions The findings on spatial relationship between suicides and alcohol psychoses incidence rates seem to support the hypothesis that considers regional pattern of alcohol-related problems as a factor responsible for suicides rate regional variations in Belarus.

Further considerations on suicides among union forces during the U.S. Civil War

In their thoughtful commentary McCutcheon et al. (2013) remind us that caution is warranted in interpreting military suicide data, in part due to the possible political, leadership, and morale pressures to disguise suicides that may have existed during the U.S. Civil War. While we agree generally, we offer further considerations on suicides among Union forces during the war. We discuss the integrity of the data source, the ratio of homicides to suicides, contemporaneous journalistic accounts regarding cultural acceptance of suicide, seasonal variations in suicides, and Dyer's Compendium. All of these points suggest support for our initial argument that suicide rates during the U.S. Civil War were much lower than modern U.S. military suicide rates. We agree with McCutcheon et al. that geography and history remind us there is good reasons to be optimistic that the psychological consequences of war are not inevitably devastating to all those who serve.

1256 – Suicide seasonality in relation to sunlight duration and serotonergic medication

Introduction Suicide seasonality with a peak incidence in spring or early summer has been consistently reported. Although a quite robust finding this spring peak of suicides is poorly understood. The effect of climate parameters such as sunlight, temperature, humidity etc. on hormones and neurotransmitters such as serotonin has been hypothesized to explain the seasonal variation in suicide. Objective To examine the amplitude of suicide seasonality in relation to sunlight duration and serotonergic medication. Methods By using Swedish Registers we gathered information including forensic data on antidepressive medication for 11,845 suicides during 1992 to 2003. Moreover, data for sunlight duration for the same period for all Swedish counties was obtained from the Swedish Meteorological and Hydrological Institute. The presence of suicide seasonality was estimated with a Poisson regression variant, in three groups, as defined by tertiles of sunlight duration. Results In regions with low sunlight duration no statistically significant seasonality pattern was found for men independently of medication. In regions with middle or high sunlight duration an increased amplitude of seasonality was observed among men treated with SSRIs in a dose dependent pattern. Such a pattern was not observed among suicide victims on other antidepressant medication or those without an antidepressant. Women on the other hand showed a seasonal variation in suicide only in regions with low sunlight duration. Conclusions Suicide seasonality amplitude increases with higher sunlight duration especially in men treated with SSRIs. In women, the highest suicide seasonality was observed in regions with the lowest sunshine duration.

THE ECONOMICS OF SUICIDE IN SOUTH AFRICA

AbstractThis study investigates the economics of suicide in South Africa using the Mortality and Causes of Death data from death notification as well as regional economic data for the 2006‐2008 period. Using an inflation rate that varies by month and across province of residence as a proxy for economic performance, the results indicate a negative relationship between inflation and suicide, suggesting that suicides are countercyclical. When controlling for month and province fixed effects, however, the inflation coefficient, albeit remaining negative, is no longer significant, except in the female sample. Suicide is more prevalent among younger individuals, while the greatest proportion of suicide is seen among men. Suicides also exhibit a strong seasonal variation, with peaks in spring and summer, with December having the highest suicide prevalence. The overall results indicate a negative but insignificant relationship between economic performance and suicide in South Africa, with socio‐economic differences and individual characteristics accounting for most of the variation in suicide.

Seasonality of Suicidal Behavior

A seasonal suicide peak in spring is highly replicated, but its specific cause is unknown. We reviewed the literature on suicide risk factors which can be associated with seasonal variation of suicide rates, assessing published articles from 1979 to 2011. Such risk factors include environmental determinants, including physical, chemical, and biological factors. We also summarized the influence of potential demographic and clinical characteristics such as age, gender, month of birth, socioeconomic status, methods of prior suicide attempt, and comorbid psychiatric and medical diseases. Comprehensive evaluation of risk factors which could be linked to the seasonal variation in suicide is important, not only to identify the major driving force for the seasonality of suicide, but also could lead to better suicide prevention in general.

Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2-20 benchmark

BackgroundThe suicide rate is a macro indicator of the population's psychosocial wellbeing and an evaluation criterion of the effectiveness of suicide prevention strategies. A high level of injury deaths of...

Impact of the growing use of narrative verdicts by coroners on geographic variations in suicide: analysis of coroners' inquest data

Coroners' death certificates form the basis of suicide statistics in England and Wales. Recent increases in coroners' use of narrative verdicts may affect the reliability of local and national suicide rates. We used Ministry of Justice data on inquests held between 2008 and 2009 and Local Authority suicide data (2001–02 and 2008–09) to investigate variations between coroners in their use of narrative verdicts and the impact of these on suicide rates, using ‘other’ verdicts (79% of which are narratives) as a proxy for narrative verdicts. There was wide geographic variation in Coroners' use of ‘other’ (mainly narrative) verdicts—they comprised between 0 and 50% (median = 9%) of verdicts given by individual coroners in 2008–09. Coroners who gave more ‘other’ verdicts gave fewer suicide verdicts (r = − 0.41; P< 0.001). In the 10 English Coroners' jurisdictions where the highest proportion of ‘other’ verdicts were given, the incidence of suicide decreased by 16% between 2001–02 and 2008–09, whereas it did not change in areas served by the 10 coroners who used narratives the least. Variation in Coroners' use of narrative verdicts influences the validity of reported regional suicide rates. Small-area suicide rates, and changes in these rates over time in the last decade, should be interpreted with caution.

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.

Seasonal variation in suicide among patients in the veterans affairs health system

Seasonal Variation in Suicide Among Patients in the Veterans Affairs Health System Olaoluwa O. Okusaga, MD; Teodor T. Postolache, MD; John F. McCarthy, PhD; Frederic C. Blow PhD; Mark Ilgen, PhD; Karen Austin, MPH; Marcia Valenstein, MD 1Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD; 2Psychiatry Residency Program, St Elizabeths Hospital, Washington, DC; 3Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Department of Veterans Affairs, Ann Arbor, MI; 4Department of Psychiatry, University of Michigan, Ann Arbor, M

Geography of suicide in Taiwan: Spatial patterning and socioeconomic correlates

In industrialised Western nations suicide rates tend to be high in inner city areas and socially fragmented neighbourhoods. Few studies have investigated spatial variations in suicide in non-Western settings. We estimated smoothed standardised mortality ratios (1999–2007) for suicide for each of the 358 Taiwanese districts (median population aged 15+: 27,000) and investigated their associations with area characteristics using Bayesian hierarchical models. The geographic distribution of suicide was similar in men and women; young people showed the greatest spatial variation in rates. Rates were highest in East Taiwan, a mostly mountainous rural area. There was no evidence of above average rates in large cities. Spatial patterns of method-specific suicide rates varied markedly, with solids/liquids poisonings showing the greatest geographic variation and hangings the least. Factors most strongly associated with area suicide rates were median household income, population density and lone-parent households. Spatial patterning of suicide in Taiwan differed from that observed in Western nations. Suicide prevention strategies should take into account unique local patterns.

S35-03 - Decreasing seasonality in suicide: A marker of more widespread treatment of depression?

The seasonal variation of suicide corresponds to the annual fluctuation of some indices of central serotonergic metabolism indicating significantly lower brain serotonergic activity in spring and summer. Low central serotonin metabolism is a strong biological correlate of some pathological behaviours, like depression, impulsivity and violent suicidal acts. Based on early findings suggesting that suicide seasonality might be the consequence of the seasonal incidence of depression-related suicides, we found that decreasing suicide seasonality might be a good marker of lowering rate of depressive suicides in the population. We recently analysed the relationship between increasing antidepressant utilization and national suicide rate of Hungary between 1998–2006, with particular regard to seasonal patterns and gender differences. Time trend analysis had been applied to investigate the correlation between trend of antidepressant prescription and both of suicide rates and seasonality index. During the 9 years of the study period there was a significant correlation between steadily increasing antidepressant prescription and continuous decline in total national suicide rate as well both in females and males, but this relationship was 8-fold stronger in males. Increasing antidepressant utilization was associated with significantly decreased seasonality of suicides only among males. As national suicide rates are affected by many factors the isolation of the result of better treatment of depression in declining suicide rates is not easy. Our results suggest that decreasing suicide seasonality could be a good marker of more widespread treatment of depression resulting in lowering rate of depression-related suicides in the population particularly among males.

Accentuation of suicides but not homicides with rising latitudes of Greenland in the sunny months

BackgroundSeasonal variation in suicides has been shown in many countries. We assessed the seasonality and the variation with latitude in suicides and homicides, and the impact of alcohol on the seasonality in suicides.MethodsOfficial computerized registers on causes of death in all Greenland during 1968–2002 were used. Sales data on beer from one of the major food store chains for July 2005–June 2006 were examined. Seasonal variation was assessed by Rayleigh's test for circular distributions.ResultsThere were a total of 1351 suicides and 308 homicides. The suicides rate varied from 4.2/100 000 person-years in 1971 to 128.4/100 000 person-years in 1987. The homicide rate varied from 2.1/100000 person-years in 1969–1970 to 34.8/100 000 person-years in 1988. Out of the 1351 suicides, 80.5% were committed by men and 19.5% by women. Median age was 25 years (n = 1351; Range 11–84 years). Violent methods of suicide were used in 95% of all cases (n = 1286). Out of the 308 homicide victims, 61% were men and 39% were women, and 13% were killed in multiple homicide events.There was a significant seasonal variation with peaks in June and troughs in the winter in all suicide cases (n = 1351, r = 0.07; Z = 7.58, p < 0.001), in violent suicides (n = 1286; r = 0.07; Z = 6.97; p < 0,001), in suicides in men (n = 1087; r = 0.07; Z = 5.39; p < 0.002) , and in women (n = 264; r = 0.10; Z = 2.36; p < 0.05), but not in homicides nor in consumption of beer. There was a bi-phasic seasonal variation in suicide victims where an alcohol-related condition was included in the death certificateSuicides were more concentrated in the summer months north of the Arctic Circle (n = 577, r = 0.09, Z = 4.45, p < 0.01) than south of it (n = 769, r = 0.07, Z = 3.76, p < 0.002) and most concentrated in North Greenland (n = 33; r = 0.35; Z = 4.11; p < 0.01), where 48% of suicides occurred during the period of constant light. When including astronomical twilight in the constant light period 82% occurred during this time.ConclusionThere was a concentration of suicides but not homicides in the summer months in all Greenland. The concentration was most pronounced at high latitudes.

Suicide among Italian adolescents: 1970–2002

The purpose of the present study was to analyze sex and regional differences in the suicide rate of adolescents and the methods they used for suicide in Italy during the period 1970-2002. Temporal trends and regional variations in suicide for Italian adolescents were retrieved from the Italian database on mortality for the period 1970-2002, collected by the Italian Census Bureau and processed by the Italian National Institute of Health-Statistics Unit. In the period 1970-2002, 3,069 adolescent suicides were monitored in Italy. Analyses of these suicides identified significant differences by region of residence and sex. Males were 2.1 times more likely than females to kill themselves. Male and female suicides had inverse trends in the years analyzed, so that the sex difference at the present time is the result of a continuous increase in male suicides and a decrease in female suicides since 1970. The dramatic peaks observed over the time period studied cannot be attributed to a single cause, indicating that further studies are needed to better understand the phenomenon.

Have urban/rural inequalities in suicide in New Zealand grown during the period 1980–2001?

Previous studies have noted that in many countries there has been a disproportionate increase in suicide in rural areas, contributing to greater urban/rural inequalities in health. This paper evaluates whether this trend was also apparent in New Zealand during the 1980s and 1990s, a period of rapid social and economic change. Using suicide incidence data for the period 1980–2001, we investigate whether urban/rural status had an effect upon rates of suicide independently of socioeconomic deprivation. While both male and female suicide rates were significantly higher in urban than rural areas in 1980–1982, by the end of the 1990s, urban/rural differences in suicide rates were not significant. The narrowing of urban/rural differences was, to some extent, a result of the growth in suicide rates in more isolated rural communities and small rural service centres. Recent geographical variations in suicide in New Zealand are therefore to a large extent similar to trends observed elsewhere, but are less marked. Potential explanations are offered for the fluctuating urban/rural inequalities in suicide including compositional arguments, rural restructuring and economic decline, social isolation and health service utilisation.

Facts and Myths about Seasonal Variation in Suicide

The prevalence of suicide presents a universal seasonal pattern. In the Northern hemisphere, suicides peak during spring and early summer and the trough occurs during winter. This peculiar pattern might be counterintuitive for everyday reasoning. Data from 1,093 medical and psychology undergraduates from Austria (382 men and 711 women; M age 25.0 yr., SD=6.6) indicated an almost perfectly reversed pattern of beliefs about suicide seasonality compared with the actual seasonal distribution. The vast majority of respondents believed the peak to be located in late autumn and early winter and the trough occurring in late spring and the summer months. Implications for education and practice are discussed.

Variation in deliberate self-harm around Christmas and New Year

Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH to a general hospital Emergency Department in Oxford, UK. Autoregression analysis of all episodes from 1976 to 2003 (controlling for day of the week, month and year) revealed significant reductions (−30% to −40%) in the occurrence of DSH compared with expected numbers on each day from December 19th to 26th (except the 23rd), though no significant increase was found on any of the subsequent 11 days. When analysed separately, young people aged under 25 years showed decreases (−60%) in the occurrence of DSH on several days throughout Christmas ( p<0.001) and New Year ( p<0.01). Patients with partner relationship problems showed a decrease 3 days before Christmas Day ( −80%, p<0.001) and an increase on New Year's Day (+100%, p<0.01). Patients with family relationship problems showed decreases before Christmas and after New Year (−60%, p<0.01). Patients with social isolation problems, or a previous history of DSH showed decreases (−60%, p<0.01) before Christmas only. Patients who used alcohol at the time of DSH or in the 6 h beforehand, but did not chronically misuse alcohol, showed an increase (+250%, p<0.01) on New Year's Day. There was no significant variation in the occurrence of DSH for patient groups with either low/medium or high suicide intent. The findings elucidate how social and individual factors may interact in contributing to DSH. They are of theoretical interest, and have important clinical implications regarding identification of patient groups especially susceptible to DSH at New Year.

Interaction between Childhood Trauma and Serotonin Transporter Gene Variation in Suicide

Although the serotonin transporter promoter polymorphism (5-HTTLPR) contributes to depression and suicidality in a fashion modulated by environmental stress, 5-HTTLPR has been little examined in relation to suicidal behavior in substance dependence. Recently, a third functional allele of 5-HTTLPR was discovered enabling more of the interindividual variation in serotonin transporter expression to be predicted by genotype. We examined whether the 5-HTTLPR gene alone, or interacting with childhood trauma, was predictive of suicidal behavior in substance-dependent patients, a clinical population that is at high risk of suicide, as well as childhood trauma and other stress. We interviewed 306 abstinent male African-American substance-dependent patients about whether they had ever attempted suicide and administered the 34-item Childhood Trauma Questionnaire (CTQ). Patients and 132 male African-American controls were genotyped to determine the S, L(G), and L(A) 5-HTTLPR alleles; some analyses grouped the S and L(G) alleles on the basis of equivalent function. The distribution of 5-HTTLPR genotypes did not differ between patients and controls, nor between suicide attempters and non-attempters. However, patients with low expression 5-HTTLPR genotypes and above-median CTQ scores were more likely to have attempted suicide. Logistic regression showed increasing risk of a suicide attempt with increasing reports of childhood trauma scores; in addition, this increase was exaggerated among those with low expression forms of the 5-HTTLPR genotype. Childhood trauma interacts with low expressing 5-HTTLPR genotypes to increase the risk of suicidal behavior among patients with substance dependence.

Seasonal Variation of Suicide in Brazil

Most of what is known about the seasonal variation in suicide rate originates from studies conducted in the northern hemisphere; very few studies have been done in the southern hemisphere. The purpose of the present study was to explore the possibility that in Brazil, the seasonal variation of suicides is a function of photoperiod. This was accomplished by analyzing monthly suicide data for a 12 yr period (1979 to 1990), within latitudes ranging from 2°N to 33°S. Single cosinor analyses with periods of 12 or 6 months were applied to time series of monthly total and suicidal deaths, separated by gender and state. Significant spring or early summer peaks of suicide were found only in the south of Brazil for both men and women, except for the latter in one state. These peaks did not coincide with those found for total deaths, which occurred in the autumn or winter in all areas. No significant six‐month period was found. In the present study, the chance of a suicide was typically 10–17% higher during the peak period than during the other months of the year. Although this moderate seasonal effect might not be sufficient to justify planning large scale prophylactic interventions, those dealing with patients who have suicide ideation should be aware of this high risk time.