Disentangling the Person and the Place as Explanations for Regional Differences in Suicide

Identifying whether suicides in a region are due to characteristics of the residents living there or to some enduring feature of the region is difficult when using cross‐sectional studies. To distinguish these factors, we compared the suicides of a region's residents with people who were temporarily visiting the region. Using U.S. death records from 1973–2004, we focused on states with the highest and lowest suicide rates over this period. The high suicide region consisted of Arizona, Colorado, Montana, New Mexico, Nevada, Oregon, and Wyoming; the low suicide region consisted of Connecticut, Illinois, Massachusetts, New Jersey, and New York. For each region, we considered three groups of decedents: residents who died inside the region, residents who died outside the region, and visitors to the region. Proportionate mortality ratios were calculated for all suicides and separately for firearm suicides. In the high suicide region, visitors to and residents away from the region both had elevated suicide levels, to about the same extent as residents dying inside the region. Therefore, short‐term exposure to the region and being a resident of the region each predicted suicide. In the low suicide region, the suicides of residents at home were reduced, but their suicides rose dramatically once they left the area. There was no decrease in suicides among visitors to the region. Firearm use was related to the suicide levels of each region. Overall, the results suggest that both the available means to commit suicide and the contextual features of the regions contributed to their extreme suicides. We discuss how an examination of visitors can help researchers generate novel inferences about the causes of suicide.     

Perception of behavioral contagion of adolescent suicide

In order to assess perceptions of behavioral contagion of suicide (what people thought a disturbed adolescent would do if the teen knew about a suicide in the community), and to assess actor-observer differences in such perceptions, 142 college students were asked to view a videotaped vignette of a distressed high school student, and then to assess her potential for committing suicide, running away, entering therapy, or abusing alcohol. Subjects who were told that the teenager knew of two recent suicides in the community (contagion group) rated the young woman as more likely to commit suicide or run away than did the subjects who were not told of the suicides (noncontagion group). Subjects who were instructed to imagine that they were the teenager (actors) blamed situational factors, and in particular the teen's parents, more for her distress than did subjects who were instructed just to rate the teenager on the videotape (observers). Contagion/actors rated suicide as more likely than did any other group. Apparently, people believe that behavioral contagion occurs when a suicide is reported, and they especially perceive themselves to be influenced by such information.     

Menstruation and suicide: an exploratory study

Previous research has reported mixed findings on the effect of the menstrual cycle on suicidal behavior. The contribution of menstruation to completed suicide is also controversial, though the studies are very limited and have not been carefully designed. To explore the relationship, 217 autopsies on completed suicides were performed, matched to a control group at the All India Institute of Medical Sciences in New Delhi. The results show that 54.46% of people who died by suicide were menstruating (results excluded pregnancies), compared to 6.75% of the control group. Menstruation in those who completed suicide, compared to a control group, appeared to have an association with suicide. More research is warranted.     

Analysis of NTSB Aircraft‐Assisted Pilot Suicides: 1982–2014

On March 24, 2015, a Germanwings aircraft crashed in the Alps. The suicidal copilot killed himself and 150 others. Pilot suicide is rare, but does happen. This research analyzed the National Transportation Safety Board's accident database (eADMS) looking for pilots who died by suicide in flight. Fifty‐one suicides were identified. Gender, age, and other characteristics were examined. Average age of suicidal pilots was 38, significantly different from the average age of 45 for all male pilots involved in aircraft accidents. A discriminant function accurately identified suicidal incidents at 96%. There was a high false‐positive rate limiting the usefulness of the discriminant function.     

Suicide among eminent artists

To evaluate suicide risk by profession among eminent artists data from Garzanti's Encyclopedia, a broad biographical repertory, were used. Six categories in the visual and literary arts were compared: architects, painters, sculptors, writers, poets, and playwrights. Only people whose deaths occurred in the 1800s or 1900s were included since it is likely that underestimation of suicide has been lower in the more recent centuries. A total of 59 suicides were observed in a sample of 3,093 people: this corresponds to a ratio of 1.90%. Suicides were 51 among men (ratio 1.75%) and 8 among women (ratio 4.30%). The comparison by profession indicates that poets and writers exceed the mean suicide ratio of the sample. Painters and architects, conversely, have a clearly lower risk than the mean. Mean age of suicides was 44 yr. (SD = 12), with writers being slightly older (48 yr., SD = 12) than other artists. Artists who died of causes other than suicide reach a mean of 65 yr. (SD = 10). Suicide among artists seems to have a peculiar pattern, clearly different from the pattern of the general population, wherein suicide risk is higher among men and older people. Adverse financial circumstances and the stress attributed to rejection of personal products may contribute to the specific risk of suicide among artists. The link between mental disorders, such as manic-depression, which imply a higher risk of suicide, and creativeness is discussed as a contributing factor.     

A Controlled Study of Suicide in Middle‐Aged and Older People: Personality Traits,Age, and Psychiatric Disorders

Personality traits were examined using the NEO Five‐Factor Inventory–Revised in an Australian psychological autopsy study involving 259 suicide deaths and 181 sudden death controls aged 35 years and over. Interviews included the Structured Clinical Interview for DSM‐IV to determine the presence of psychiatric disorder. Personality traits of suicide deaths differed significantly from those of controls, scoring higher in the Neuroticism and Openness to Experience domains and lower on the Agreeableness and Extraversion domains. These findings varied with the presence of psychiatric disorder and by age. High Neuroticism scores were the most consistent finding in people who died by suicide, although these scores decreased in older suicides.     

Alcohol and suicide death among American Indians of New Mexico: 1980-1998

The relationship between alcohol use prior to suicide was explored among American Indian decedents in New Mexico for the years 1980 through 1998. The suicide data were collected from New Mexico Vital Statistics and toxicology reports from the New Mexico Office of the Medical Investigator and matched on a case-by-case basis. Detailed analyses were undertaken for all cases of resident New Mexico Indians from the Navajo, Pueblo, and Apache cultures. Alcohol was detected in 69% of all suicides of American Indians with some variance by major tribal cultural groups (range = 62.1% to 84.4%). This is higher than in suicides among the overall New Mexico population (44.3%). The mean blood alcohol concentration (BAC) of the drinking Indian decedents at suicide was 0.198 (+/- SD of .088). Mean BACs were high for both males (0.199) and females (0.180) who had been drinking. Over 90% of the Indian decedents who had been drinking had BACs greater than the legal intoxication level of 0.08. The Navajo had the lowest percentage of cases that were alcohol involved, and their mean BAC was lower than the other two cultural groups. Alcohol use for completed suicides also varied somewhat by age, sex, method of suicide, and place of occurrence, but very little by whether the decedent was an on or off reservation resident. Analyses indicated that alcohol use prior to suicide was significantly more associated with male suicides than for females, and it was negatively correlated for those who died by overdose and also those using other drugs at suicide. Otherwise, alcohol use did not significantly differentiate American Indian suicides by age, use of firearms, hanging, use of other methods, or residence, for the presence of alcohol was a factor very commonly associated with all of these variables. Heavy alcohol consumption is, therefore, an important factor in over two thirds of all completed suicides among the Indians of New Mexico.     

A Comparison of Suicide and Undetermined Deaths in Psychiatric Patients

ABSTRACT: Those people who had previously been patients of the Department of Mental Health of Missouri who died in the three year period 1972 through 1974 and whose deaths were designated as suicide or “undetermined whether purposely or accidentally inflicted,” were identified by matching statewide death tapes against the DMH data base. The demographic characteristics of the two groups are compared to ascertain if the members of the undetermined group are essentially similar to the suicides, as has frequently been hypothesized. It is found that, in general, the similarities are in areas which would not have had a direct influence on the medical examiner/coroner's verdict, whereas, the differences do highlight areas which could cause an indecisive verdict. The significance of the undetermined deaths is discussed.     

The usefulness of coroners' data on suicides for providing information relevant to prevention

Coroners' records are an accessible source of information on suicides. To assess their usefulness in relation to the investigation of specific methods of suicide, we examined coroners' records for 492 suicides across 24 jurisdictions in England. Generally data on demographic variables were well recorded. Information on contact with general practitioner and psychiatric services was less commonly available. Where those who had self-poisoned died in hospital, information on treatment and blood levels of drugs taken were not routinely available. For suicides by hanging, information on the source of ligature was frequently missing. Where firearms were used, information about licensing and storage were not routinely recorded. Generally there was wide variation across coroners in information relevant to specific methods. The use of standardized forms by coroners would assist studies of factors associated with suicide and potentially provide a representative source of information relevant to suicide prevention.     

Suicide in the army national guard: an empirical inquiry

Since 2004, suicides in the U.S. military have risen, most notably in the Army National Guard (ARNG). Data used in this study were obtained for suicides occurring from 2007 to 2010 and for a random sample of nonsuicides from the general ARNG population. Of the military-related variables considered, a few showed relationships to suicide. Rather, the primary variables associated with suicide were soldier background characteristics, including age (17-24 years), race (White), and gender (male). Cluster analysis revealed two distinct suicide groups: "careerists" (about one third of all suicides) and "first-termers" (about two thirds of all suicides), each group exhibiting different concurrent behavioral problems.     

Correlates of motives for suicide

Analysis of a large sample of suicide notes from 262 suicides in Australia showed separated/divorced suicides and suicides who abused alcohol were more likely to give love/romance as a precipitant for suicide while those who used gas (natural or car exhaust) were more likely to give depression and guilt as a motive.     

Patterns of suicide among hospitalized mentally disordered offenders

The case records of 29 mentally disordered offenders who committed suicide in a state hospital were reviewed. Information was collected on demographic and clinical characteristics; time, method and location of the suicides; and the presence of suicide indicators. Comparisons were made between the characteristics of the suicide patients and those of the current hospital population. Major findings were: 80 percent of the suicides were committed by psychotic patients and 66 percent were by patients with diagnoses which included paranoia; 48 percent of the suicide patients had been charged with or convicted of murder or attempted murder; most suicides occurred in individual patient rooms; nearly 50 percent of the patients had a history of suicide attempts; and other common indicators of suicide risk were often masked by psychotic symptomatology. Several recommendations for identifying and managing potentially suicidal patients in this population are presented.     

Who Leaves Suicide Notes? A Six‐Year Population‐Based Study

Popular culture insists on the significance of suicide notes, but research has yielded conflicting results about who leaves notes. Utilizing 6 years of suicides from a comprehensive statewide data surveillance system, differences were examined between cases with suicide notes and those without in terms of demographics, circumstances of the suicide, and precipitating circumstances. Of the 2,936 suicides, 18.25% included a note. Demographics and circumstances did not differ for cases with a note compared to cases with no note. Results have implications for working with people bereaved by suicide in helping understand that the notes are uncommon and not systematic. However, it is also possible that for some individuals, the content of a note is meaningful and can help or hinder their course of bereavement.     

Demographic, criminal, and psychiatric factors related to inmate suicide

A review of 19 studies suggests that it may be feasible to identify prisoners with suicide risk on the basis of demographic, psychiatric, and criminal characteristics. The present study aimed to identify combinations of characteristics that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of six characteristics (age 40+, homelessness, history of psychiatric care, history of drug abuse, one prior incarceration, violent offence) was capable of correctly classifying 82% of the Dutch suicide victims (82% specificity). Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. It is concluded that a set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons.     

Suicidal behavior in jails and prisons in The Netherlands: incidence, characteristics, and prevention

In most countries, the incidence of suicidal behavior in correctional institutions is higher than in the population at large. In the current study, information was processed on 44 completed suicides (that occurred during the period 1973-1984) and on 198 attempted suicides (1980-1984) by jail and prison inmates in The Netherlands. Demographic, legal, and medical data for victims were compared to similar data for nonsuicidal inmates. Twenty-five inmates who had recently attempted suicide were interviewed, as well as 26 correctional officers and staff members. The majority of suicide completers died by hanging; most attempted suicides were performed impulsively by cutting wrists. Suicidal crises often occurred during the first period of confinement. Inmates born outside The Netherlands and long-term prisoners were high-risk groups. The incarceration of alcohol and/or drug abusers was a complicating issue. Correctional officers and prison staff often viewed suicide attempts as manipulative gestures, although this only partially reflected inmates' true intentions. Several preventive measures are discussed, with special consideration of the identification of suicide risk.     

Homicide Followed by Suicide: A Comparison with Homicide and Suicide

Homicide‐suicides are a rare yet very serious form of lethal violence which mainly occurs in partnerships and families. The extent to which homicide‐suicide can be understood as being primarily a homicide or a suicide event, or rather a category of its own is examined. In total, 103 homicide‐suicides were compared to 3,203 homicides and 17,751 suicides. These are all events that took place in the Netherlands in the period 1992 to 2006. Logistic regression analyses show that homicide‐suicides significantly differ from both homicides and suicides with regard to sociodemographic and event characteristics. The findings suggest that homicide‐suicide might be considered as a distinct phenomenon from both homicide and suicide.     

Musical creativity and suicide

The different abilities involved in artistic creativity may be mirrored by differences among mental disorders prevalent in each artistic profession, taking poets, painters, and composers as examples. Using suicide rates as a proxy for the prevalence of mental disorders in groups of artists, we investigated the percentage of deaths by suicide in a sample of 4,564 eminent artists who died in the 19th and 20th centuries. Of the sample, 2,259 were primarily involved in activities of a linguistic nature, e.g., poets and writers; 834 were primarily visual artists, such as painters and sculptors; and 1,471 were musicians (composers and instrumentalists). There were 63 suicides in the sample (1.3% of total deaths). Musicians as a group had lower suicide rates than literary and visual artists. Beyond socioeconomic reasons, which might favour interpretations based on effects of health selection, the lower rate of suicides among musicians may reflect some protective effect arising from music.     

Suicide among Attempted Suicides

ABSTRACT: A 10-year follow-up is presented of 484 patients who made serious suicide attempts. Of this group 23% had died, 9% from natural causes, 3% from accidents or from uncertain causes, and 11% from suicide. Suicide frequency is highest in the period immediately after the suicide attempt. Especially interesting is the distribution according to sex. During the first 5 years there is a preponderance of male suicides (which is in agreement with the findings of other investigators), but after 10 years this difference in sex disappears. Suicides are found especially among men from 50 to 60 years of age, disabled pensioners, and persons who have attempted suicide several times, and to a lesser degree among persons living alone and criminals.     

The newsworthiness of suicide

There is a paucity of studies examining which suicides are considered news-worthy. By combining data on media reports of individuals' suicides with routinely collected suicide data, it was found that 1% of Australian suicides were reported over a 1-year period. There was evidence of over-reporting of suicides by older people and females, and those involving dramatic methods. Reported suicides fell into three groups: suicides reported in a broader context; suicides by celebrities; and suicides involving unusual circumstances/methods. The data suggest a need for media professionals and suicide experts to work together to balance newsworthiness against the risk of copycat behavior.