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.     

Suicide in Batman, southeastern Turkey

The southeastern part of Turkey has comparatively high female suicide rates. We aimed to research social, economic, cultural, and psychiatric reasons of suicides in Batman in a case-controlled psychological autopsy study comparing suicides with matched community controls. The female suicide rate was 9.3 per 100.000 and the female/male ratio was 1.72/1. The suicides most frequently occurred in young females, mean age 20.7. The most frequent method (45%) was hanging. The most frequent stressful life events were health problems and family disruption. High suicide rates among females may be related to negative social status of females living in the region.     

A Follow-up Study of 53 Suicides Known to a Suicide Prevention Center

ABSTRACT: The operation of the Cleveland Suicide Prevention Center is reviewed, and 53 known suicides during the Center's first four years of operation are discussed. A suicide rate of 288 per 100,000 suggests that persons contacting the Center represented a high suicide risk group. Of the suicides, 57 percent were women. This high proportion of females was statistically significant when compared to the smaller percentage of female suicides for Cuyahoga County, Ohio. Of the persons who committed suicide, 26 percent initiated direct contact with the Center themselves, and none recontacted the Center just prior to death. The question is raised whether contact initiated by another may in itself be suggestive of greater suicidal risk. Some of the practical problems in evaluation and referral are discussed.     

Occupational status and suicide

The relationship between occupational status and suicide was examined using data from Sacramento County, California. Data were obtained from coroner's records filed routinely on all cases of sudden, violent, or unexpected death since 1925. Occupation- and age-specific suicide rates were calculated for males and age-adjusted for overall comparison for the decades 1945-1954, 1955-1964, and 1965-1974. Findings show an inverse relationship between occupational status and suicide for all age groups over the past 30 years. Over time, male suicide rates have increased particularly for employed males over 65, employed males aged 14 to 24, and males in low-status occupations. General economic insecurity among workers of low socioeconomic status (SES), particularly the elderly, is suggested as a contributing factor to these trends.     

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.     

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.     

Gender and Suicide Risk: The Role of Wound Site

That males have higher suicide rates than females is one of the most empirically documented social facts in suicidology, but the reasons for this continue to be debated. For the present paper, we tested a neglected contributing factor to the gender suicide ratio: wound site or the area of the body that is wounded in firearm suicides. Males may have a higher suicide rate, in part, due to their greater likelihood than women for shooting themselves in the head as opposed to the body. This has been related to gender differences in fear of facial disfigurement and suicide intent. Data from the Wayne County Medical examiner's office regarding 807 suicides committed with firearms was analyzed. The dependent variable was dichotomous and referred to the location of the site of the wound: gunshot to the head vs. gunshot to the body. Controls for demographic covariates of suicide included age and race of the suicide victim. The results of the multivariate logistic regression analysis determined that women were 47% less apt than men to shoot themselves in the head. Further analysis determined that women were less apt than men to use shotguns and rifles in their suicides (weapons that make head shooting more awkward). The findings are consistent with the notion that women are more concerned than men with facial disfigurement, and that women have a lower desire to die than men.     

Dependent children and suicide of married parents.

In an attempt to analyze the relatively neglected relationship between the presence of dependent children and suicide of married parents, the suicides of both married and single persons in the Chicago-Cook County region for 1970 and 1974 were examined. Single suicides and married suicides with dependent children were compared to similar groups in the general population. It was found that while marrieds with dependent children experienced the lowest average suicide rate, they also had a larger mean number of children than the population as a whole and exhibited a tendency for having children at a very young age or children at an older age in life. These findings contradict contemporary notions that an increasing number of children in a marriage tend to inhibit suicide potential. It appears that the relationship between marital suicide and dependent children is far more complex than previously indicated and requires further research for elaboration.     

A demographic analysis of suicide among U.S. Navy personnel

Age-, sex-, race-, and employment-adjusted standardized mortality ratios (SMRs) were calculated for sailors committing suicide between 1990 and 1996 and compared with adjusted SMRs for civilians. Cluster analyses were conducted on annual rates from 1983 through 1995 to examine differences between comparison groups across time and location. Results showed fewer than expected suicides for Caucasian and African American males and a somewhat higher than expected suicide rate among other ethnic group males and among Caucasian women. The suicide rate showed an increase during the study period, with some evidence toward a clustering effect in time and space.     

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.     

The Kurt Cobain Suicide Crisis: Perspectives from Research,Public Health,and the News Media

The suicide of rock star Kurt Cobain in 1994 raised immediate concerns among suicidologists and the public at large about the potential for his death to spark copycat suicides, especially among vulnerable youth. The Seattle community, where Cobain lived and died, was especially affected by his sudden death. An overview of Cobain's life and death is presented and various crisis center and community-based interventions that occurred are discussed. Preliminary data collected from the Seattle Medical Examiner's Office and from the Seattle Crisis Center to assess the potential impact of Cobain's death on completed suicides and the incidence of suicide crisis calls are presented. The data obtained from the Seattle King County area suggest that the expected “Werther effect” apparently did not occur, but there was a significant increase in suicide crisis calls following his death. It is hypothesized that the lack of an apparent copycat effect in Seattle may be due to various aspects of the media coverage, the method used in Cobain's suicide, and the crisis center and community outreach interventions that occurred. The Cobain suicide and the role of media influence on copycat suicides are further discussed in commentaries from public health and news media perspectives.     

Tobacco and alcohol tax relationships with suicide in Switzerland

Previous research has shown an empirical link between tobacco and alcohol use and suicide. If tobacco and alcohol use contribute to suicidal behaviors, then policies designed to reduce the tobacco and alcohol consumption may succeed in reducing suicides as well. To test this hypothesis, correlations for suicide rates with alcohol consumption, taxes on alcohol and tobacco in Switzerland were examined using sets of time-series data from Switzerland in 1965-1994. The tax on tobacco correlated significantly negatively with male standardized suicide rate. The tax on alcohol also correlated significantly with male standardized suicide rate in an autoregressive model. On the other hand, significant relationships with female suicide rate were not found. Policies designed to reduce tobacco consumption are consistent with a benefit of reducing suicides, particularly for men in this 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.     

Helpline: suicide prevention at a suicide site

In an effort to reduce the number of suicides from the Mid-Hutson Bridge in Poughkeepsie, New York, the Dutchess County Department of Mental Hygiene and the New York State Bridge Authority jointly established a suicide prevention phone on the bridge, which is directly connected to a 24-hour psychiatric emergency service. This program is the first known one in which a dedicated suicide prevention helpline has been installed at a site of known suicides and linked with a mental health service. After 2 years of operation, the phone has been used 30 times; the data suggest that most would-be jumpers are ambivalent enough about dying that they will reach out for help/contact if the opportunity exists, and, as a consequence, can be saved.     

Sex differences in adolescent suicides in Norway, 1990-1992

All suicides in persons under 20 years in Norway in the time period 1990-1992 (99 males, 30 females) were included in a postmortem case-control study with seven controls for each suicide, focusing on gender differences. Few sex differences between the suicide completers were evident, in spite of the difference in suicide rates (M/F rate ratio = 3.0). Females more often attempted suicide (p = .05), more often wrote farewell notes (p = .03), and used less violent suicide methods (ns). The adjusted risk for suicide related to affective disorders (Female OR = 22,1; Male OR = 24.0, both p = .000) and disruptive disorders (female OR = 14,7, ns; male OR = 5.0, p = .002) differed little, as did the effect of frequent use of alcohol or substances (female OR = 0.4, ns; male OR = 0.4, ns).     

The Big Ten Student Suicide Study: A 10-Year Study of Suicides on Midwestern University Campuses

The Big Ten Student Suicide Study was undertaken from 1980–1990 to determine the suicide rates on Big Ten University campuses. The study design attempted to address many of the statistical and epidemiological flaws identified in previous studies of campus student suicides. The 10-year study collected demographic and correlational data on 261 suicides of registered students at 12 midwestern campuses. The largest number of suicides for both males and females were in the 20–24-year-old age group (46%), and amongst graduate students (32%). The overall student suicide rate of 7.5/100,000 is one half of the computed national suicide rate (15.0/100,000) for a matched sample by age, gender, and race. Despite the overall lower suicide rate, the analyses revealed that students 25 and over have a significantly higher risk than younger students. Although women have rates roughly half those of men throughout their undergraduate years, graduate women have rates not significantly different from their male counterparts (graduate women 9.1/100,000 and graduate men 11.6/100,000).     

A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic characteristics, reported affect before death, precipitating events, physical and mental health status and care, and method of suicide. The only differences found were that note writers were more likely to have lived alone and had made prior suicide threats. These findings suggest that for research purposes, suicide cases with and without notes are essentially similar.     

Adequacy of Official Suicide Statistics for Scientific Research and Public Policy

Many researchers have claimed that the study of suicide and the formation of public policy are not undermined by the misclassification of suicide as other causes of death. We evaluated this claim using a new technique and causes of death not previously considered. We examined computerized California death certificates, 1966-1990. Mortality peaks at symbolic ages are a characteristic feature of suicide. We sought such peaks in (1) causes of death commonly suspected of containing misclassified suicides (e.g., accidental barbiturate poisoning), (2) causes of death not hitherto suspected (e.g., pedestrian deaths), and (3) control groups. The first two categories displayed peaks at symbolic ages, but control groups did not. The size of the peak, indicative of misclassified suicides, varied markedly by race (p < .0001) and sex (p < .0001). Misclassification is evident for all time periods examined, large and small counties, and each race and sex. The maximum misclassification occurs for Blacks (14.92% of officially recorded suicides). We conclude that suicides are misallocated to at least five other causes of death (two of which have not been previously considered in the literature) and are most likely to be underreported for groups with low official suicide rates, that is, Blacks and females. Consequently, Blacks and females are not as protected from suicide as was previously supposed. It may be inadvisable to use official suicide data to test scientific hypotheses about suicide, unless the effects of underreporting are estimated and, if necessary, corrected for.     

Does Culture Make a Difference? Racial/Ethnic Patterns of Completed Suicide in San Francisco,CA 1987–1996 and Clinical Applications

Completed suicides in San Francisco were examined in the racial groups of African Americans, Asians, Caucasians, Hispanics, and Native Americans for a 10-year period (1987–1996). Comparisons of rates across race and gender showed that both Caucasian men and women had the highest rates. Significant differences were found when racial groups were compared across age groups, gender, and method, but no significant difference was found in the use of firearms as a method of suicide. Differences and similarities are illustrated by comparing Caucasian and Asian patterns of suicide in the areas of (1) suicide in Asian homelands, (2) cultural context, and (3) cultural beliefs regarding psychopathology. A framework relating cultural variables to predisposing client variables is suggested for clinicians and researchers.     

On precipitating factors: cancer as a cause of suicide

This case-control study provides individual-based data describing the impact of being a cancer patient on the odds of suicide. 5,009 suicides and 17,064 controls are compared. The data indicate that cancer patients are 50 to 100 percent more likely than nonpatients to commit suicide. This and other studies indicate that health status should be considered in future attempts to relate suicide to social environment.