Variation in suicide occurrence by time of day, day of the week, month, and lunar phase

Previous studies suggest that suicide occurrence varies by month and day of the week, but not by lunar phase. Variation by time of day has never before been adequately examined; to our knowledge, all previous studies have failed to obtain time-of-death information for a large percentage of cases. We examined suicide occurrence among residents of Sacramento County, CA, during the period from 1925 to 1983. Data were abstracted from coroner's autopsy and investigative reports. In contrast to previous studies, data on time of death were available for a large percentage of cases. 4,190 suicide deaths were identified during the study period. Suicide occurrence varied substantially by time of day; for both sexes and for ages under 65 years, the fewest suicide deaths occurred during the early morning hours, from 0401 to 0800. For recent years of the study, suicides occurred most frequently on Monday for both males and females and for most age groups. Variation by month followed no consistent pattern by gender, age, years of the study, or combinations of these factors. Contrary to popular belief, suicide occurrence did not vary by lunar phase.     

Comparison of suicides among Anglos and Hispanics in five southwestern states

Little is known about deaths resulting from self-inflicted violent behavior for Hispanic Americans. To learn more about suicide for Hispanics of Mexican origin (Mexican Americans) we focused on the five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) in which more than 60% of all Hispanics in the United States reside (86% of whom are Mexican American). We obtained data on the number of suicide deaths in the white population, with Hispanics and Anglos (white, non-Hispanic) identified separately. Suicides of Anglos were used as a comparison group. Results show that the suicide rate for whites in the five southwestern states (15.6) was almost one-fourth higher than the rate for whites nationally (12.7). Suicide rates for the two ethnic groups, however, showed the rate for Hispanics (9.0) to be less than the national rates for whites (12.7) and one-half that of Anglos residing in the same area (17.3). The lower suicide rate for Hispanics relative to Anglos is seen for both males and females. The ratio of male and female suicides for Hispanics was almost twice that for Anglos (4.0 to 1 for Hispanics and 2.3 to 1 for Anglos). More than 1 in 3 Hispanic men who committed suicide and more than 1 in 4 Hispanic women who committed suicide are under the age of 25.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Sex differences in mortality rates among long-stay psychiatric inpatients

Study of the sex ratio of mortality rates among three categories of long-term psychiatric inpatients suggests a trend toward equalization of death rates between the sexes by specific cause of death, given the constant inpatient environment. The most dramatic example of this equalization was the virtual parity of death rates for ischemic heart disease among younger schizophrenic patients of both sexes in contrast to a three- to fourfold male excess in the general population. An exception to this equalization was seen for neoplasm deaths, which showed a female excess in all three patient groups in contrast to the male excess seen in the general population. Further study of chronically hospitalized psychiatric patients seems indicated to delineate patterns of death associated with biologic variation in a relatively constant environment.     

Depression and suicide in schizophrenic patients

This study supports the idea that schizophrenic patients represent a distinctive subgroup of patients who can suffer from a major depressive illness and also can commit suicide. The study showed that 22.4% of the schizophrenic population in a medium-sized psychiatric facility showed severe depressive symptoms that met the criteria for the diagnosis of a major depressive episode according to the DSM-III classification. Seven patients committed suicide during the acute phase of the illness--five during hospitalization, and two within a year of discharge. Nine patients attempted suicide during the hospitalization period, and 10 attempted suicide within a year of discharge. Nearly one-third (215) of the patients were readmitted during that year because of a recurrence of acute schizophrenic symptoms; of these, 84 were having severe depressive symptoms. The study also provides indications of the causes of suicide in these patients.     

Association of suicide rates for elderly age bands with gender equality

A lower sex ratio (male to female) of elderly suicide rates in several Asian countries have been attributed to gender inequality on several parameters. The association of two proxy measures of gender equality (value of the gender empowerment measure and the gender-related development index) and the male to female sex ratio of suicide rates in the age bands 65-74 yr. and 75+ yr. was examined using multiple linear regression. The two proxy measures of gender equality did not account for significant variance in the male to female sex ratio of suicide rates in the age bands 65-74 yr. and 75+ yr. Association of gender equality with the male to female sex ratio of suicide rates requires further clarification in both cross-sectional studies across different countries and longitudinal studies within individual countries for all age bands. Such studies should, in addition to the GEM and the GDI, include other measures of gender equality including sex differences in educational attainment, income, poverty, housing, employment, access to healthcare and social welfare services, and urbanisation.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.     

Modifiable risk factors for attempted suicide in Australian clinical and community samples

Modifiable risk factors for suicide attempt require identification in clinical and community samples. The aim of this study was to determine if similar social and psychiatric factors are associated with suicide attempts in community and clinical settings and whether the magnitude of effect is greater in clinical populations. Two case-control studies were used: nationwide community-based lifetime attempted suicide (ComAS) cases compared to nationwide community controls; and clinical deliberate self-poisoning (ClinDSP) cases that had hospital treatment compared to normative controls of similar demographic composition. The pattern of risk factors in ComAS and ClinDSP cases was similar, the magnitude of risk usually greater in clinical cases. Greatest attributable fractions were: ComAS current unemployment (39.8% male, 15.5% female) and anxiety disorders (14.0% males, 22.6% females); and ClinDSP current unemployment (69.6% male, 55.5% female) and affective disorders (45.4% male, 39.1% female). Practical intervention targets were unemployment, anxiety and substance use disorders, affective disorders (clinical only), and personality disorder (females only).     

Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients

Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.     

Outpatient health care utilization of suicide decedents in their last year of life

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care.     

Premature mortality due to suicide, homicide, and motor vehicle accidents in health service delivery areas: comparison of status Indians in British Columbia, Canada, with all other residents

From each of 15 health regions, potential years of life lost (PYLL) before age 75 for Status Indians is compared for select causes of death with all other residents. Mortality data from 1991 to 2001 for rates of PYLL (standardized to the 1991 population) are from tables of the British Columbia Vital Statistics Agency and First Nations and Inuit Health Branch in 2002. PYLL rate differences and rate ratios were compared for two groups with significance of the former indicated by the 95% confidence interval. Overall, the rates of PYLL for suicide, homicide, and deaths due to motor vehicle accidents were about 224%, 340%, and 248% higher among Status Indians than all other residents. Rates of PYLL for homicide and deaths from motor vehicle accidents among Status Indian women exceeded those of other residents who were men. For suicide, Status Indian men ranked first and all other male residents of British Columbia ranked second.     

The Media and Suicide: Evidence‐Based on Population Data over 9 Years in Taiwan

The relationship between the regional distribution densities of different media and the suicide death rate was explored by analyzing the annual total, male, and female suicide rates and media densities from 23 cities/counties in Taiwan during 1998–2006 by univariate and multivariate regression adjusted for five socioeconomic factors. The regional density of newspapers was significantly inversely related to the total, male, and female suicide rates, while that of television sets was not. The density of in‐home personal computers was significantly positively related to the total and male suicide rates, but not the female suicide rate. The results indicate that media reporting on suicide can be beneficial, instead of harmful, depending on the content.     

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.     

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

National intelligence and suicide rate across Europe: an alternative test using educational attainment data

National mean scores on a historical knowledge test (taken as a proxy for intelligence), stemming from representative samples of male (and female) 9th-grade school students from 26 European countries in a 1999 report by Wilberg and Lynn, were significantly positively associated with the national male (and female) suicide rates, independent of the general quality-of-living conditions in these countries. This finding replicates previous evidence from cross-national studies (by Lester and by Voracek), of a correspondence of higher national IQ to higher suicide rates, with an alternative measure of national IQ that is independent of the national IQ estimates recently published by Lynn and Vanhanen which have been used in prior studies.     

Trends in attempted suicide in Denmark, 1976-1980

The object of the present study was to estimate proportions and changes in the incidence of suicide attempts in Denmark. Case sheets concerning all admissions in 1976-1979 (total 6,650) at the Department of Psychiatry, Odense University Hospital (the catchment area of which provides a representative sample of the Danish population), were examined with a view to establishing the reasons for admission. Rates of suicide attempts by age and sex in 1976-1979 were calculated, and estimated rates of the suicide attempts in 1980 added. Trend analysis showed an increase in the mean rates from 1976 to 1979 of 48%, followed by a decrease in 1980 of 13%. There were high increases among the adolescents, but the increase was above all due to the fact that more and more men attempted suicide; the study suggests as a new phenomenon more male than female suicide attempters. We stress the fact that incidences calculated on the basis of hospital admissions only underestimate the real proportions of self-destructive behavior.     

Changing age patterns of U.S. male and female suicide rates, 1934-1983

Changes in the age patterns of U.S. male and female suicide rates from 1934 to 1983 are examined, using official suicide data. Among whites, the age patterns of male and female suicide rates have become less concordant since about 1960. In contrast, the age patterns of nonwhite male and female suicide rates have become more concordant since the mid-1950s. A review of sociological theories of suicide identifies problems in accounting for such changes--problems stemming in part from what has been a theoretical emphasis on cross-sectional relations.     

Generalization effects of social skills training in chronic schizophrenics: An experimental analysis

Social skills training was administered to three (one male and two female) chronic schizophrenic patients in a Partial Hospitalization Service. Treatment consisted of instructions. feedback and modeling, and was administered in 25. 26 and 31 sessions, respectively, for the three patients. Target behaviors were identified for each patient based on his/her responses to role-played interactions involving male and female partners in situations requiring commendatory or hostile assertion. Five to seven target behaviors were selected for each subject and were treated sequentially in a multiple baseline format. Skills training was highly successful for the two female patients but was only partially effective for the male patient. Two forms of generalization measures were included, indicating that the effects of training generalized from trained to untrained, and trained to novel role-played interactions. Follow-up assessments for the two female patients indicated that most of the effects persisted over 8–10-week post-treatment periods.     

Modernization and the Male–Female Suicide Ratio in India 1967–1997: Divergence or Convergence?

The traditional view that modernization is likely to increase male vulnerability to suicide while protecting females from such self-destruction was offered by Durkheim (1951). This implies a theory of divergence of suicide rates such that the male-female suicide ratio should increase with modernization. Contemporary researchers have questioned whether modernization has had such an impact. We conducted a time series analysis of male and female suicide data to determine the impact on the suicide ratio for India for the years 1967 to 1997. We developed a modernization index comprised of urbanization, female literacy, and female work participation rates. Moreover, to improve methodological efficacy, we controlled for the passage of time. However, we found that there is no significant relationship between modernization and the male-female suicide ratio. Our conclusion is that using national male-female suicide ratios to determine modernization effects may mask significant regional gender and age differences, particularly in developing countries such as India.