Mortality and Causes of Death in a 10-Year Follow-Up of Patients Treated for Self-Poisonings in Oslo

The present 10-year follow-up study includes all patients (N = 926; 50% females) treated in the medical departments in Oslo for self-poisonings during one year (1980). Seventeen percent were considered suicidal attempts upon admission, 25% among the non-substance abusers and 8% among the abusers. At follow-up, 207 patients (22%) were dead (62% males). The mortality rate was highest among the abusers. The most common causes of death were suicide (21%), heart disease (17%), opiate abuse (15%), and accidents/wounds (13%). Forty-one percent of the suicides occurred during the first two years of the follow-up period. The suicides were by poisoning (57%), hanging (20%), and other methods (23%). The female mortality rate decreased in the second half of the follow-up period whereas the male rate did not change. The risk of death within 10 years after discharge increased with age and was higher in men and in abusers, whereas social group and motive for suicide were not predictive factors. The females had an excess suicide rate of 182 (36–327, 95% CI) in the first year after the self-poisoning and 61 (36–87, 95% CI) in the total period. The corresponding figures for males were 70 (19–122) and 21 (12–30). The only factor associated with an increased suicide rate was a suicidal motive upon the admission for self-poisoning with a 3.1 (1.7–5.8, 95% CI) times increased risk of suicide in the 10-year follow-up period.     

Epidemiologic Characteristics and Trends of Fatal Suicides among the Elderly in Taiwan

Taiwan has one of the highest suicide rates in the world, especially among its elderly. The epidemiologic characteristics and trends of the surging elderly suicide rates from 1993 to 2003 are described, with a special emphasis on the risk groups, the methods used in suicide, and their geographical variations. Data on annual mortality for persons over 65 years of age with external cause‐of‐death codes E950–E959 were obtained from the Death Certification data file provided by the Department of Health and used in the analysis. The suicide rate for each 5‐year age group over 65 years old increased during the 11‐year period. Elderly males had the highest suicide rate and experienced an increased rate of 49% during the decade. The average suicide ratio between elderly males and females was about 2:1. Never‐married males had the highest age‐adjusted as well as sex‐ and marital status‐specific suicide rates, and showed an increased rate of 66% over the 11‐year period. Geographical variations in suicide rates were significant, with the lest urbanized eastern Taiwan having a higher rate than other regions. Hanging, strangulation, and suffocation were the most used methods for committing suicide by the elderly, but their use had decreased from 63% to 54% during the decade; but jumping off a building and drowning increased significantly. Variation in suicide rate among months was not significant. With the increase in the elderly suicide rate, more governmental and societal interventions are needed to alleviate this social and human problem.     

Mental Disorders and Socioeconomic Status: Impact on Population Risk of Attempted Suicide in Australia

The population attributable risk (PAR) of mental disorders compared to indicators of socioeconomic status (SES) for attempted suicide was estimated for Australia. For mental disorders, the highest PAR% for attempted suicide was for anxiety disorders (males 28%; females 36%). For SES, the highest PAR% for attempted suicide in males was for occupation (males 31%; females 16%) and education level (males 19%; females 8%), following adjustment for age and mental disorders. The study results suggest that one third of suicide attempts in both males and females are attributable to anxiety disorders, the same proportion attributable to low educational or occupational status.     

Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth

We examined hopelessness as a predictor of suicide ideation in depressed youth after acute medication treatment. A total of 158 depressed adolescents were administered the Children's Depression Rating Scale‐Revised (CDRS‐R) and Columbia Suicide Severity Rating Scale (C‐SSRS) as part of a larger battery at baseline and at weekly visits across 6 weeks of acute fluoxetine treatment. The Beck Hopelessness Scale (BHS) was administered at baseline and week 6. A negative binomial regression model via a generalized estimating equation analysis of repeated measures was used to estimate suicide ideation over the 6 weeks of acute treatment from baseline measure of hopelessness. Depression severity and gender were included as covariates in the model. The negative binomial analysis was also conducted separately for the sample of males and females (in a gender‐stratified analysis). Mean CDRS‐R total scores were 60.30 ± 8.93 at baseline and 34.65 ± 10.41 at week 6. Mean baseline and week 6 BHS scores were 9.57 ± 5.51 and 5.59 ± 5.38, respectively. Per the C‐SSRS, 43.04% and 83.54% reported having no suicide ideation at baseline and at week 6, respectively. The analyses revealed that baseline hopelessness was positively related to suicide ideation over treatment (p = .0027), independent of changes in depression severity. This significant finding persisted only for females (p = .0024). These results indicate the importance of early identification of hopelessness.     

Youth Suicide Deaths: Investigation of Clinical Predictors in a Statewide Sample

Death by suicide is a significant cause of mortality among youth. However, there is limited information on the demographic and clinical factors associated with youth suicide deaths. The objective of this study was to link large statewide databases to describe demographic, clinical, and cause of death characteristics among youth who died by suicide. We examined 1,218 decedents under age 26 who died by suicie between 2000 and 2014. Eighteen died before age 12, 53 died between ages 12 and 14, 292 died between ages 15 and 18, and 855 died between ages 19 and 25. Most were male (83%), and firearm was most common cause of death; 28% previously attempted suicide, 31% had a mental health diagnosis, and 17% were prescribed psychotropic medication. Younger children died by hanging/smothering (89% of all 7‐ to 11‐year olds), and overdose/poisoning increased progressively with age. Adolescents had a higher proportion of females than young adults (23% vs. 14%, p  = .002). Combining data from the medical examiner and large hospital systems allows examination of youth suicide from a developmental perspective. Differences between age groups included gender, method, diagnosed mental illness, and diagnosis of attention deficit hyperactivity disorder. These data point to missed opportunities for effective interventions for specific developmental stages.     

High rates of paraquat-induced suicide in southern Trinidad.

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3%) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8% were in the age group 25-34 (p < 0.001), and among the females 50.0% were in the 15-24 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, followed by marital problems. Individuals of East Indian origin accounted for 89% of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.     

How Often Does Deliberate Self‐Harm Occur Relative to Each Suicide? A Study of Variations by Gender and Age

Deliberate self‐harm (DSH; i.e., nonfatal self‐poisoning or self‐injury) occurs much more frequently than suicide, yet there has been little detailed investigation of the comparative rates of DSH and suicide. We conducted a study of how rates of DSH relate to suicide rates across the life cycle by gender and by method of estimation of DSH rates, using 10 years of data from a local system for monitoring DSH presentations to a general hospital and national and local suicide statistics. The rate‐ratio of DSH to suicide was 36 (95% CI 34.9–37.1) based on annual person‐based rates of DSH episodes and was nearly five times higher in females (87.9; 95% CI 84.4–91.6) than in males (18.7; 95% CI 17.9–19.6). The ratio varied markedly across the life cycle, decreasing from more than 200 in teenagers to less than 10 in persons aged 60 years and over. The difference in the ratio between females and males also decreased over the life cycle. There were very similar findings when local suicide rates were used. These patterns were replicated when the data were analyzed, first, on the basis of all episodes of DSH during the study period, but with expectedly larger DSH:suicide ratios (e.g., overall 52.7; 95% CI 51.4–54.1), and second, on the basis of individual persons only engaging in DSH during the study period, but with smaller ratios (e.g., overall 26.2; 95% CI 25.4–27.2). The DSH:suicide rate ratios for those with high and low suicidal intent were similar within age groups except for those aged 60 years and over, in whom there was a greater proportion of high intent acts. These findings illustrate how the nature of self‐harming behavior may vary in intention across the life cycle and between the genders, and provide a basis for further comparative work of this kind.     

Sexual Assault,Overweight, and Suicide Attempts in U.S. Adolescents

Associations between overweight, sexual assault history, and suicide attempts were examined among 31,540 adolescents from the combined 2009 and 2011 nationally representative Youth Risk Behavior Surveys samples. These variables have not previously been studied concurrently. It was hypothesized that overweight and sexual assault, together, would interact and result in increased suicide attempts. Findings across analyses included (a) no significant associations between sexual assault and overweight in females or males (p = .65 and p = .90, respectively), (b) statistically significant associations between female (but not male) overweight status and suicide attempts (p = .001), (c) a strong association between sexual assault and suicide risk in males (p < .001) and females (p < .001), and (d) an elevated risk for suicide in overweight males with co‐occurring sexual assault, with over 33% of males with such histories attempting suicide. Preliminary findings have powerful implications for research and secondary prevention.     

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).     

I Can Stomach That! Fearlessness About Death Predicts Attenuated Facial Electromyography Activity in Response to Death‐Related Images

Objective measures of suicide risk can convey life‐saving information to clinicians, but few such measures exist. This study examined an objective measure of fearlessness about death (FAD), testing whether FAD relates to self‐reported and physiological aversion to death. Females (n = 87) reported FAD and disgust sensitivity, and facial electromyography was used to measure physiological facial responses consistent with disgust while viewing death‐related images. FAD predicted attenuated expression of physiological death aversion, even when controlling for self‐reported death‐related disgust sensitivity. Diminished physiological aversion to death‐related stimuli holds promise as an objective measure of FAD and suicide risk.     

Adolescent Suicidal Ideation Subgroups and their Association with Suicidal Plans and Attempts in Young Adulthood

Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13‐year period from 552 Caucasian adolescents. Three subgroups were found: non‐ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).     

The Longitudinal Association of Being Bullied and Gender with Suicide Ideations,Self‐Harm,and Suicide Attempts from Adolescence to Young Adulthood: A Cohort Study

Longitudinal associations between being bullied during adolescence and suicide ideations, self‐harm, and suicide attempts into young adulthood were examined. A large representative sample was examined in 1998 (N  = 2,464, MA 13.7), 1999/2000, and 2012 to reassess the outcome measures. At all ages, bullied participants showed more suicide ideation, self‐harm, and suicide attempts, regardless of gender. Bullied females showed a decrease in suicide ideation from adolescence to adulthood, while bullied males showed an increase in suicide attempts in the same time period. Being bullied in adolescence strongly predicts suicidal behavior and self‐harm. Preventive efforts might reduce the risk of later suicidality.     

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.     

Hospitalizations for Suicide‐Related Drug Poisonings and Co‐occurring Alcohol Overdoses in Adolescents (Ages 12–17) and Young Adults (Ages 18–24) in the United States, 1999–2008: Results from the Nationwide Inpatient Sample

Drug poisoning is the leading method of suicide‐related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide‐related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates of inpatient hospital stays for SRDP and co‐occurring alcohol overdoses in adolescents (ages 12–17) and young adults (ages 18–24) between 1999 and 2008. Among adolescents, there were 14,615 hospitalizations for drug poisonings in 2008, of which 72% (10,462) were suicide‐related at a cost of $43 million. Rates of SRDP in this age group decreased between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 5% in 1999 to 7% in 2008. Among young adults, there were 32,471 hospitalizations for drug poisonings in 2008, of which 64% (20,746) were suicide‐related at a cost of $110 million. Rates of SRDP did not change significantly between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 14% in 1999 to 20% in 2008. Thus, while rates of SRDP decreased for adolescents and remained unchanged for young adults, the prevalence of co‐occurring alcohol overdoses increased for both age groups. Such hospitalizations provide important opportunities to employ intervention techniques to prevent further suicide attempts.     

Adolescents' attitudes toward suicide, and a suicidal peer: A comparison between Swedish and Turkish high school students

The present paper first presents the attitudes toward suicide and a suicidal classmate among 98 female and 69 male (N = 167) Swedish high school students. Secondly, the Swedish sample was compared with 167 (89 female and 78 male) Turkish high school students from a previous study. Among Swedish students, more males than females said that people have the right to commit suicide and suicide can be a solution to some problems. More females than males expressed a belief in life after death. Swedish adolescents were found to be holding more liberal attitudes toward suicide than Turkish adolescents. However, Turkish adolescents showed greater acceptance for a suicidal peer than Swedish adolescents. The results are discussed in terms of socio-cultural factors and related literature. The need for educational programs to provide basic knowledge about suicide and, effective ways of dealing with and helping suicidal peers is implicated.     

A Century of Suicide in Italy: A Comparison between the Old and the Young

This study analyzes suicide rates from 1887 to 1993 in the Italian population between the ages of 15 and 24 years old and over 65 years of age, based on official data published in the Health Statistics Year Book. The rates of death by suicide (per 100,000) subjects) are calculated for each year and for 10-year periods, as are the mortality rates relative to each method of suicide, standardized by gender. The latter analysis was possible starting from 1951 only, when it became customary to record method. The findings indicate an increase in the suicide phenomenon in the elderly population in Italy over the test period. Rates are at least 3 times higher for men than for women. The highest rates are reported for elderly men, but there appears to have been a greater proportional increase in the number of suicides committed by elderly women. The rise was statistically significant in both males and females. By contrast, a rather constant decrease in suicide rates in young people emerges from the beginning of the century through to the present date. This decrease is more marked in females, although suicide rates are lower for females than for males. Over the study period, substantial changes have come about in the suicide methods used by both young and old people. There was an increase in poisoning by care exhaust fumes, jumping from heights, hanging, and firearms.     

The Prevalence of and Psychosocial Risks for Suicide Attempts in Male and Female College Students in Taiwan

The prevalence of and psychosocial risks for suicide attempts was investigated in college students in Taiwan by gender, after controlling for depressive symptoms. Self‐reported data were collected from a nationally representative sample of 2,835 college students; 11.90% of females and 8.87% of males reported they had attempted suicide in the preceding 12 months. After controlling for depression, suicidal ideations were associated with suicide attempts in females, whereas there were fewer positive expectations toward the future associated with suicide attempts in males. Several explanations for the high prevalence of suicide attempts among college students in Taiwan were discussed. In the future, further verification of the findings is necessary.     

Combat Exposure and Risk for Suicidal Thoughts and Behaviors Among Military Personnel and Veterans: A Systematic Review and Meta‐Analysis

Due to seemingly mixed empirical results, questions persist about the possible role of deployments and combat exposure. We conducted a narrative review and meta‐analysis of 22 published studies to integrate findings regarding the relationship of deployment‐related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to specific combat events) with suicide‐related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors and outcomes, the combined effect was small and positive, r = .08 [0.04, 0.13], and marked by significant heterogeneity, I² = 99.9%, Q(21)=4880.16, p < .0001, corresponding to a 25% increased risk for suicide‐related outcomes among those who have deployed. Studies examining the relationship between exposure to killing and atrocities (k = 5) showed the largest combined effect, r = .12 [0.08, 0.17], and less heterogeneity, I² = 84.4%, Q(4)=34.96, p < .0001, corresponding to a 43% increased risk for suicide‐related outcomes among those exposed to killing or atrocity. Implications for theory, research, and clinical practice are discussed.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.     

Childhood Parental Death and Lifetime Suicide Attempt of the Opposite‐Gender Offspring in a Nationwide Community Sample of Korea

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one‐person‐per‐household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32–15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97–16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13–4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite‐gender offspring, especially when exposure occurs before age 10.