A cluster analysis of the circumstances of death in suicides in Hong Kong

Classification of suicides is essential for clinicians to better identify self-harm patients with future suicidal risks. This study examined potential subtypes of suicide in a psychological autopsy sample (N = 148) in Hong Kong. Hierarchical cluster analysis extracted two subgroups of subjects in terms of expressed deliberation assessed by the Beck Suicide Intent Scale (SIS). The first group was associated with charcoal burning suicide, no psychiatric illness, indebtedness, better problem-solving ability, chronic stress, and higher overall SIS scores. The second group was associated with jumping from a height, psychotic disorders, psychiatric treatment, acute stress, and lower overall SIS score. The existence of a substantial cluster of subjects with lower expressed intent and preparation has important implications for the performance of the SIS as a predictive tool. Suicide prevention strategy may have to target potential subgroups with specific approaches.     

Suicide in the Israeli army

The present study was an attempt to analyze the problem of suicide in the Israel Defense Forces (IDF). Suicide is increasing among populations aged 18-21, which in Israel is the age when most young people are called up for a 3-year period of compulsory military service. The service may have a catalytic effect on suicide. but on the other hand may serve as a control mechanism reducing suicide. The study used data for the period 1974-1985, and examined suicide in combat and noncombat units by duration of service and by preservice psychiatric, medical, and motivational data. The suicide groups were also compared with a matched sample of nonsuicide groups along the relevant variables. The findings seem to be consistent with some established theoretical perspectives of situational stress, social support, and status incompatibility, and seem to bear practical implications for the reduction of suicide.     

Prevention of Youth Suicide: How Well Informed Are the Potential Gatekeepers of Adolescents in Distress?

Australia has one of the higher rates of suicide among young people. Although a role for doctors and teachers in the prevention of youth suicide has been suggested, no prior Australian study has assessed adequately the level of suicide knowledge held by these professionals. Knowledge about adolescent suicide was investigated using the Adolescent Suicide Behaviour Questionnaire, a 39-item instrument developed for the purpose. The stratified random sample comprised 404 general practitioners and 481 teachers from 56 secondary schools. General practitioners and teachers scored, on average, 71% and 59% of the questionnaire items correct, respectively. There was wide individual variability: The number of items correct ranged from 4 to 38 for general practitioners and 0 to 34 for teachers. Strengths and deficits in knowledge across the two professions are discussed in terms of the potential gatekeeping role of these professionals in suicide prevention.     

Meanings of Loss Among Japanese Suicide Bereaved: Content Analysis of Open-Ended Responses1

Although the importance of meaning-making among suicide bereaved has been reported, the detailed contents of the process remain unclear. This study aimed to identify the content categories of sense-making and benefit-finding in Japanese suicide loss survivors. We conducted content analysis of responses to open-ended questions in 99 participants. The results indicated that sense-making activities comprised seven categories, including Deceased was relieved from pain and Suicide is inevitable in modern society. Benefit-finding also comprised eight categories, such as Treat others with compassion and Live one day at a time with gratitude. The implications of the results are discussed in terms of sociocultural contexts of suicide postvention.     

Association between obesity and suicide in woman,but not in man: a population-based study of young adults

The relationship between obesity and suicide risk is still unclear with controversial research results. The aim of this study is to investigate the relationship between obesity and suicide risk for men and women in a population-based study of young adults. This is a cross-sectional population-based study that identified young adults between 18 and 35 years of age. Suicide risk was investigated through the structured clinical interview Mini. Weight and height were assessed, and participants were classified as normal-weight body mass index (BMI < 30) or obese (BMI > 30). The prevalence of obesity was of 19.9% of the total sample (n = 1953). Obesity was more prevalent among women and participants between 27 and 35 years of age. Suicide risk was present in 13.0% of the sample and more prevalent among women. In our study we found an association between obesity and suicide risk for women, but not for men. Obesity was associated with a higher prevalence of suicide risk in women. Given the strength of the relationship between BMI and suicide, identifying the mechanisms associated with obesity, especially for women, can lead to new insights into the prevention of suicide risk     

A model for the description and interpretation of suicide prevention.

Views about suicide prevention are based on underlying beliefs about the origins of problems and basic concepts about humankind. These implicit theories have an effect on prevention practices. Making these views explicit is one of the keys for the further development of suicide prevention. In this study a paradigm for analyzing suicide prevention of means of a coding frame and interpreting findings by means of theoretical models of prevention was elaborated. The analysis was based on empirical data consisting of definitions of prevention given by psychologists (N = 34) participating in the national suicide prevention project in Finland. The study demonstrates that suicide prevention can be differentiated at the operational level by means of the analysis method generated. Moreover, the findings can be interpreted according to theoretical criteria. Views expressed by the psychologists seemed to correspond largely to central features of current prevention models. Furthermore, the data can be seen to serve as an empirical validation of these models. Suicide prevention proved to be a multifactorial concept manifesting mainly process theory and interactional explanations of suicidality, and prevention practices fell into a simple typology of four categories.     

Cannabis use and the risk behavior syndrome in Italian university students: are they related to suicide risk?

The aim of this study was to examine the association of cannabis use with risky behaviors and suicide risk in university students. A convenience sample of 246 students was recruited from four universities in Rome during the 2004 academic year. Participants completed the Zung scales for anxiety and depression, the Suicide Score Scale, and an ad hoc questionnaire assessing risky behaviors. The findings indicated a widespread use of cannabis among students and its association with risky behaviors, anxiety and depression, and suicide risk. A regression tree analysis resulted in 3 splits indicating that the Zung Self-Rating Depression Scale is a good predictor of suicide risk, discriminating individuals at lower risk from those at higher risk. Individuals at higher risk for suicide could also be discriminated by self-reported lifetime drug use. Limitations of the study are related to the small sample size and use of a convenience sample.     

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Gender Differences in PTSD diagnostic Criteria and Suicidal Ideation in a South African Police Sample

The study examined gender effects on PTSD symptoms to predict of suicidal ideation in a sample of South African police. A male (N = 161) and a female group (N = 56) of South African police officers were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and stepwise regressions were used to determine which PTSD symptom criteria best predict suicide ideation. Hyperarousal was the primary predictor of suicide ideation in males. For females, intrusive memories was the primary predictor of suicide ideation, and of general problems.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Perfectionism and Suicide Ideation in Adolescent Psychiatric Patients

This study was conducted to examine the relations between dimensions of perfectionism and suicide ideation in an adolescent psychiatric sample. A sample of 66 adolescents from an inpatient psychiatric facility completed the Child and Adolescent Perfectionism Scale, the Child's Hopelessness Scale, and the Suicide Ideation Questionnaire. Overall, the results indicated that socially prescribed perfectionism was associated with greater suicide ideation and that it, along with hopelessness, accounted for unique variance in suicide ideation scores. The findings are discussed in terms of their practical and theoretical significance as well as their consistency with similar research with adults.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Suicide compared to other causes of mortality in physicians

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results about cause-specific mortality such as suicide. In this study, we compared all-cause and cause-specific mortality in a sample of physicians to the age-gender matched general U.S. population from 1948 through 1998. We also compared the mortality experience across medical specialties. The risk of all-cause mortality was 56% lower than expected in men, and 26% lower in women, compared to the general population. Standardized mortality ratios (SMRs) were markedly lower for diseases strongly linked to smoking, e.g., cardiovascular diseases, respiratory diseases, and lung cancer. Suicide was the only cause of death where risk was greater than the general population. Overall, we found that physicians are at substantially lower risk of dying compared to the general population for all causes of death except suicide. The findings for suicide are strikingly different than other causes of death and should provide impetus for new research on the mental health of physicians.     

Factor Composition of the Suicide Intent Scale

An exploratory analysis of the Suicide Intent Scale was performed on a sample of 98 psychiatric inpatients who had made suicide attempts. The factor analysis was performed using a method for polychotomous data, and resulted in a two-factor solution. The Lethal Intent factor contained items pertaining to the subjective level of lethal intent, while the Planning factor contained items largely related to objective planning for the attempt. Preliminary analysis of these factors suggest that the Suicide Intent Scale can be used to evaluate two separate aspects of suicidal behavior.     

CSF 5-HIAA Predicts Suicide Risk After Attempted Suicide

Suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, was studied in a sample of 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. The potential of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF to predict suicide risk within the first year after attempted suicide was studied by means of survival analysis after median split sub-grouping. Eleven patients (12%) committed suicide within 1 year after attempted suicide. Eight of these belonged to the below-the-median (< 87 nM) CSF 5-HIAA subgroup, that is, the suicide risk was 17% as compared with 7% among those with above-the-median CSF 5-HIAA. The cumulative number of survived patient-months during the first year after attempted suicide was significantly lower in the low CSF 5-HIAA subgroup. It was concluded that low CSF 5-HIAA predicts short-range suicide risk after attempted suicide in mood disorder psychiatric inpatients. These findings lend further support to the serotonin hypothesis of suicide risk.     

Suicide without explicit precursors: a state of secret despair?

Although it is usually assumed that all those who commit suicide give some prior indication of their intention to take their own life, there is growing evidence that a small but significant proportion of suicides occur without any clear, explicit indicators. It is proposed that these suicides share similar pathways to other suicides but that the despair involved is not expressed so clearly, often being kept secret. In order to identify such suicides and potential suicides it is helpful to have an indicator of the dominant sub‐sets of constituents that are precursors to suicide. A 14‐item Suicide Precursors Scale (SPS) was therefore developed. This was applied to 128 cases of suicide that occurred between January 1997 and December 2000 in Stockport (South Manchester, UK). A very high alpha coefficient of 0.98 supported the reliability and homogeneity of the SPS. A Multi‐Dimensional Scaling (MDS) analysis of the SPS revealed three prototypical sub‐sets of expressions of suicidal actions—illness, life circumstances, and depressive history. These are offered as coherent themes in the life of potential suicides, which may be of assistance both in determining whether an equivocal death is suicide or not, and in alerting caring agencies to the potential for suicide even when the despair is kept secret. Copyright © 2004 John Wiley & Sons, Ltd.     

Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration

Suicide risk is thought to increase with a greater potential for activation of suicide-related schemas. Suicide schemas are less likely to be activated with reductions of emotional range associated with certain negative symptoms of schizophrenia. The study tested whether suicide risk would increase in patients with recent onset schizophrenia with increased potential for suicide schema activation as indicated by lower levels of specific negative symptoms that reflected emotional reactivity, namely emotional withdrawal and blunted affect. A logistic regression analysis of baseline data of 278 recent onset schizophrenic patients with a measure of suicide behaviour as the dependent variable and negative symptoms, delusions, hallucinations, depression, gender, episode, ethnicity, education, age, duration of untreated psychosis and substance use as independent variables was carried out. Emotional withdrawal, but not blunted affect was significant and negatively associated, and depression positively associated with suicide behaviour. There was evidence to indicate that restricted emotions are associated with reduced suicide risk as predicted.     

Prison suicides in Austria, 1975-1997

Suicide prevention in custody is hampered by the lack of funds and professional staff. In order to evaluate the prison suicide phenomenon, a study was conducted evaluating all suicides that occurred in Austrian prisons between 1975 and 1997 (n = 220). In addition to evaluating the number of male versus female suicides, the preferred suicide methods were studied, as well as suicide risk of different circumstances of custody. Suicide rates of distinguishable, important subgroups of prisoners were calculated. The suicide rate for prisoners on remand was 236.0 per 100,000, and for offenders classified as mentally ill it was 205.4 per 100,000. That is about 8 times higher than the suicide rate in Austria's general population (1975-1997: 24.6 per 100,000). The suicide rate for sentenced offenders was 81.3 per 100,000, about twice the suicide rate in Austria's general male population. We recommend that psychologists or psychiatrists concentrate on the suicide prevention of high-risk offenders after screening the newly admitted offenders for their propensity to suicide.     

The Impact of Exercise on Suicide Risk: Examining Pathways through Depression,PTSD, and Sleep in an Inpatient Sample of Veterans

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.