The epidemiology of suicide and attempted suicide

Since more than one century suicides have been registered in national statistics of death causes. They thus furnish one of the few parameters of psychiatrically relevant behaviour by means of which trends, cohort, age-group and period effects can be studied over longer periods. Since the second half of last century, the suicide rates for Swiss males--similar to those found in England and Wales--show a decrease in consecutive birth cohorts up to males born in the decade 1930-1940, and a continued decline in the total trend until about World War II. From then on the suicide rates of males in consecutive birth cohorts have been slowly increasing in the majority of European and North American countries--but not so in Sweden. Opposite to this, the predominantly low rates for females display little change. Further to the considerable differences between nations and the predominance of suicides committed by females in some Asian countries and Cuba, the changes indicate the significance of cultural and economic environmental factors. Typical period effects are mainly the result of changes in conception and conditions of life. In attempted suicide they proceed in a more sensitive and more rapid way and are about ten times higher. Such a period effect showing increases by about 300% in younger age-groups followed by a decline, attaining its peak about 1976, was ascertained in large cities of the Federal Republic of Germany. By the example of the effects of a television serial, the study of causal processes turning collective environmental factors into individual suicidal behaviour, proved that regularities are effective in learning by a process of modelling. Besides, the epidemiological data give essential hints how to treat suicidal behaviour.     

Moral development and perceptions of attempted suicide and physician-assisted suicide

In a sample of 115 undergraduates, no association was found between a measure of moral development and the perception of attempted suicides. For the 85 women in the sample, a higher moral development score was associated with less approval of physician-assisted suicide.     

Sex differences in verbal fluency: a short note

Adult male and female subjects performed two fluency tasks from the ‘Kit of Reference Tests for Cognitive Factors’. Although both word fluency and ideational fluency are said to show female superiority, a significant difference in favour of females could be found only in the task which primarily requires lexical access and not in the task requiring mental access to colour and form of objects.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Sex differences in verbal fluency: a short note

Adult male and female subjects performed two fluency tasks from the 'Kit of Reference Tests for Cognitive Factors'. Although both word fluency and ideational fluency are said to show female superiority, a significant difference in favour of females could be found only in the task which primarily requires lexical access and not in the task requiring mental access to colour and form of objects.     

A case control study of suicide and attempted suicide in older adults

Risk factors for serious suicidal behavior among older adults were examined in a case control study of 53 adults aged 55 and older who died by suicide or made medically serious suicide attempts and who were compared with 269 randomly selected comparison subjects. Multivariate analyses suggested that risk of serious suicidal behavior was elevated among those with current mood disorders (OR = 179, CI = 52.8-607.6), psychiatric hospital admission within the previous year (OR = 24.4, CI = 1.9-318.7), limited social network (OR = 4.5, CI = 1.4-14.6). The predominant role of mood disorders was confirmed by population attributable risk (PAR) estimates (73.6%), suggesting that the improved detection, treatment and management of mood disorders should be the primary focus of suicide prevention strategies for older adults.     

Verbal fluency and verbal comprehension abilities in synonym tasks

Generating different synonym candidates and evaluating these candidates with respect to their synonymy with the stimulus word are two components of solving an open synonym task, which requires giving synonyms for a given word (cf. Janssen, Hoskens, & De Boeck, 1993). Separate subtasks were designed to identify these components. It is shown in this study that the generation component ability is primarily related to verbal fluency abilities, whereas the evaluation component ability is primarily related to verbal comprehension abilities. Moreover, evidence is given that these two component abilities can account for the correlations of the open synonym task with other ability measures.     

Sex differences in verbal fluency: the role of strategies and instructions

Sex differences in verbal fluency performance and strategies are highly controversial, nevertheless suggesting a slight female advantage at least for phonemic fluency. A tendency of increased clustering of words into phonemic and semantic subcategories in men and increased switching between those categories in women has been suggested. In spatial tasks, it has been demonstrated that changes in instructions favoring a certain cognitive strategy can alter sex differences in performance. Such an approach has, however, not been attempted previously with verbal tasks. In the present investigation, 19 women in their luteal cycle phase and 23 men performed a phonemic and a semantic fluency task with three different instructions, one neutral, one emphasizing the clustering, and one emphasizing the switching of words. While under neutral instructions no sex differences were observed in verbal fluency performance and strategies, sex differences in switching and overall performance were observed in semantic fluency with an instruction requiring a switching strategy. Furthermore, correlation analyses suggested that the importance of strategies for overall performance differed between women and men. While only switching, but not clustering was related to overall verbal fluency performance in all tasks under all instructions, this relationship was driven by women in the phonemic task, but by men in the semantic task. These results highlight the importance of a consistent methodology in sex difference research. Slight variations in instructions may in part explain inconsistencies regarding sex differences in verbal fluency between previous studies.     

Suicidal behavior in Italy: data, trends and guidelines for a suicide intervention/prevention policy.

Even though in Italy, as in the majority of Mediterranean countries, the increase in suicide rates is not among the highest in Europe, between 1969 and 1989 it showed a sharp upswing (+43% among males and +31% among females). In terms of geographical differences, the regions with the highest suicide rate are the northern ones (up to twice the national average). The age groups with the highest suicide risk are those over 74 years (in 1989 the rate among males over 65 was the highest of all: 31.3 per 100,000). The differences in the between-sexes distribution show that among females over 65 years old the suicide rate rose by 70% between 1974 and 1989, versus 77% for males of the same age. The preliminary epidemiological results of one of two Italian centers are presented. These centers are collaborating with the WHO/EURO Multicenter Study on Parasuicide; parasuicide rates are higher for females than for males (55.9 per 100,000, as against 38.1 for males), while the age group at highest risk is seen to be young women (15-24 years), with a specific rate of 115.6.     

Declines in switching underlie verbal fluency changes after unilateral pallidal surgery in Parkinson's disease

Declines in verbal fluency are consistently reported in patients with Parkinson's disease (PD) after pallidal surgery. In the present study, the clustering and switching components of semantic or category fluency (oral naming of items obtainable in supermarkets) were examined at baseline and four months after unilateral deep brain stimulation or pallidotomy in 45 patients with PD (30 left, 15 right pallidal surgery). Post-operative declines were observed for supermarket fluency total score and switching, but not for average cluster size. These findings support the proposal that semantic fluency decrements after pallidal surgery reflect a disruption of frontal-basal ganglia circuits mediating efficient shifting between semantic categories, or perhaps efficient access to categories, rather than a degradation of semantic stores.     

Developmental aspects of verbal fluency and confrontation naming in children

Developmental changes in children's verbal fluency and confrontation naming were explored in this study. One hundred and sixty children (ages 5 years and 11 months to 11 years and 4 months) completed two verbal fluency tasks (phonemic and semantic) and the Boston Naming Test (BNT). Normative data were compiled for the BNT and the phonemic and semantic fluency tasks. With the exception of the phonemic fluency task, all tests showed a linear increase from year-groups I to V, with a significant increase between year-groups I and II. Principal Component Factor Analysis was conducted to determine whether the tests evaluated similar or different functions. Two factors emerged: the first involving all of the measurements and the second explaining exclusively the phonemic fluency. These results make it possible to conclude that children also seem to have different subsystems responsible for the analysis and processing of different aspects of language.     

Suicide and attempted suicide: their relation to subjective social stress indicators

We investigated the relationship between the subjective perception of external stress and suicidal behavior, using a stress model which indicated that the probability of suicide and attempted suicide, as a reaction to stress, increases when social support systems fail or malfunction. We conceived the subjective perception of social stress as expressions of worry or dissatisfaction regarding cardinal life domains such as economic, security, or political situations. We defined support systems in terms of national solidarity expressed as positive (or improved) attitudes regarding the relations between various segments of the population, and we derived the data regarding the subjective indicators from continuing surveys of representative samples of urban Israeli population during the years 1967 through 1979. Eight stress indicators and three solidarity indicators were included, and our findings generally supported the theoretical model. However, the findings regarding men conformed best in relation to suicide, whereas those regarding women confirmed the theoretical model mainly in relation to attempted suicide. Contrary to the model, female suicide rates decreased in times of stress. Feelings of social solidarity in the population were found to reduce suicidal behavior of both men and women.     

Suicidal behavior in the municipality of Baerum, Norway: a 12-year prospective study of parasuicide and suicide

The present 12-year (1984-1995) surveillance study includes all hospitalized parasuicide patients (n = 1,031) as well as all suicides (n = 161) in the municipality of Baerum, a suburb of Oslo. The parasuicide rate decreased from 170 per 100,000 in 1984 to 79 per 100,000 in 1995 (53.5%). The parasuicide rates were lower than those in several comparable studies. Rates were higher for divorced females and separated males compared to married and other marital states, and the pattern of relative risk of parasuicide with respect to marital status was stable. Unemployment and substance abuse were positively correlated with parasuicidal behavior for both males and females. Approximately 33% reported one or more previous parasuicidal acts, and 21% repeated the parasuicide during the observation period. Ninety-four percent used self-poisoning as parasuicide method. A total of 2.4% of the parasuiciders committed suicide during the observation period. The mean annual suicide rate in Baerum was 19.0 per 100,000 compared to the national average of 14.7. The results support the notion of parasuicide and suicide being two different but overlapping populations. The implementation of a follow-up system for parasuiciders may have contributed to the reduced parasuicide rate during the study period.