A Cross‐National Study of the Relationship Between Elderly Suicide Rates and Urbaninzation

There is mixed evidence of a relationship between suicide rates in the general population and urbanization, and a paucity of studies examining this relationship in the elderly. A cross‐national study with curve estimation regression model analysis, was undertaken to examine the a priori hypothesis that the relationship between elderly suicide rates and urbanization would be curvilinear and follow an inverted U‐shaped curve. There was a curvilinear relationship between male suicide rates in both the elderly age‐bands and the percentage of the population living in urban areas, but this was not observed in females. A three‐stage sequential model was developed to explain the observed relationship between suicide rates in elderly males and urbanization. The relationship between suicide rates in elderly females and urbanization.     

The Relationship between General Population Suicide Rates and the Internet: A Cross‐National Study

Internet Web sites and chat rooms have been reported both to promote suicides and have a positive beneficial effect on suicidal individuals. There is a paucity of studies examining the role of the Internet in general population suicide rates. The relationship between general population suicide rates and the prevalence of Internet users was examined in a cross‐national study using data from the World Health Organization and the United Nations Web sites. The prevalence of Internet users was significantly and positively correlated with general population suicide rates in both sexes. On multiple regression analysis the prevalence of Internet users was independently associated with general population suicide rates in males, and this independent relationship in females approached statistical significance. Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross‐sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.     

Suicide among adolescents and young adults: a cross-national comparison of 34 countries

Few cross-national reports have examined suicide rates among adolescents and young adults. A survey of suicides among 15-24-year-olds in 34 of the wealthiest nations demonstrated that 15,555 youths killed themselves in a 1-year study period. Thirty-four percent of these suicides were firearm-related. Finland led the participating nations in total and firearm-related suicide rates. An association was found between divorce rates and youth suicide rates, firearm-related suicide among youths, and suicide rates among young males. For a smaller sample of countries, an association was found between firearm availability and firearm-related suicide rates among youths and suicide rates among young males.     

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.     

Suicides among family members of elderly suicide victims: an exploratory study

This exploratory study compares elderly suicides with (n=13) and without (n=72) family member suicide. Previous episodes of suicidal behavior were more common among suicides who lost first-degree relatives by suicide (100% vs. 65%, p = .009). Six persons had lost an offspring by suicide prior to their own deaths. Substance use disorder was more prevalent among those with offspring suicide than those without (100% vs. 25%, p = .000). While informants reported that offspring suicides played a central role in the suicide of the elderly study case, sibbling suicides were not considered precipitating factors.     

The effects of changes in the World Health Organization's International Classification of Diseases on suicide rates in 71 countries, 1950-1999

The World Health Organization (WHO) provides annual mortality statistics from 1950 onward based on the International Classification of Diseases (ICD). In this paper we evaluate the effects of ICD form revisions on suicide rates for 71 countries. The changes between ICD-6, ICD-7, ICD-8, and ICD-9 did not have an overall effect on reported suicide rates. The transitions to ICD-8 and ICD-9 were, however, associated with country-specific changes in the suicide rate in some countries. The change from ICD-9 to ICD-10 was associated with an overall change of -.73 suicides per 100,000 inhabitants. It is recommended that researchers using the WHO mortality data for longitudinal cross-national studies control for the ICD form used at different time points.     

Social Status and Relational System of Elderly Suicides: A Reexamination of the Henry-Short Thesis*

ABSTRACT: The relationship between status and suicide has not been clearly established. Henry and Short suggested a direct relationship, but subsequent research has proposed an inverse association. The present study of elderly males uses information obtained from two sources: (a) a random sample of the aged population studied in Pinellas County, Florida, in 1959; and (b) persons aged 65 and over who committed suicide in that county between 1955 and 1963. The major findings are: (a) the highest suicide rate is found at the lowest class level, suggesting an inverse relationship; (b) class differential in suicide is explained by a direct relationship between class and the relational system; and (c) controlling on the relational system results in a direct association between class and suicide. Thus, both status and the relational system operate independently and jointly to affect suicide rates of these elderly males. Findings suggest that both Henry and Short and later investigators are partially correct. The relationship between status and suicide may be clarified by taking into account other factors which are class related but which perhaps are more significant than measures of class alone.     

Older Adults: The Next Suicide Epidemic?

Suicide rates historically and currently are highest by age among those over the age of 65. Predictions of markedly higher rates for future older adults have been advanced. Possible alternative factors that might produce lower risk among future elderly Americans are presented and it is argued that future trends are uncertain. Predictions of elderly suicide are made based on an assumption of stable rather than changing rates. Constant rates produce estimates of more than twice the current number of suicides and a proportionate increase in the number of suicides from one in five for the 1980s to one in three by the year 2030. The elderly are and likely will be a group with high suicide risk. Immediate efforts to lower elderly suicide risk and avert high future rates are recommended.     

Biology of elderly suicide.

Most studies of suicide in younger patients have demonstrated significant alterations in the serotonin system. Although a high percentage of completed suicides occur in late-life, to date very few studies of the biology of suicide have focused on this age group. This chapter describes age-related changes in the central nervous system pertinent to the biology of suicide, then reviews post-mortem biological studies of the brains of suicides and suicide attempters. As suicide attempts in the elderly are characterized by the use of violent means, biologic studies of impulsive violence are discussed. Finally we describe data on the effect of degenerative diseases on the serotonin system and the possible link to increased suicidal behavior in affected patients. This review underscores the need for further study of the biology of suicide in the geriatric age group.     

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.     

Double Jeopardy: Suicide Rates in Forensic Hospitals

While a number of studies have described high and increasing rates of completed suicide among psychiatric patients, the suicide risk of forensic hospital patients is virtually unknown. This paper reports on the suicides that have taken place in the country's oldest continually operating institution housing persons formerly labeled “criminally insane,” the Bridgewater State Hospital. The results show considerable variation in the suicide rate by historical period, with suicide prior to 1968 a considerably more infrequent event. By contrast, the post-′68 rate of 232 per 100,000 is comparable to data reported in a series of studies of psychiatric suicides, and significantly higher than that found in U.S. studies of correctional populations. These differences are discussed. The results strongly suggest that forensic hospital populations have suicide rates broadly comparable to other psychiatric populations.     

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.     

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.     

Association of suicide rates of elderly persons with fertility rates

A negative correlation between societal suicide rates and social integration has been reported, but rarely specifically examined for suicide rates of the elderly although suicide rates of elderly persons are among the highest. The associations of suicide rates of elderly persons and fertility rates for 81 countries were examined using data from the World Health Organisation and United Nations. Fertility rates were considered a proxy measure for social integration. Multiple regression analysis indicated that suicide rates for males and females in the age bands 65-74 years and 75+ years were independently (negative) correlated with fertility rates. Fertility rates, as a measure of social integration, may interact with, modify and mediate the effect of cultural factors on suicide rates of elderly persons.     

Possible relationship of elderly suicide rates with unemployment in society: a cross-national study

Analyses of individual and aggregated data have yielded an association between suicide and unemployment, particularly for men in younger age groups. Examination of the relationship of elderly suicide rates with measures of unemployment in a cross-national study of 27 countries did not produce any statistically significant association between these two variables. Also, the magnitude of the actual correlations was small. One reason for low magnitude of correlations may be better welfare systems in the studied countries which mainly reported medium and high income.     

Suicide Prevention in Adults (Age 30–65)

Relatively little is known about midlife suicides, compared to adolescent and elderly suicides. A life-span model of suicidal behaviors is suggested as a heuristic conceptual tool. General midlife tasks and crises, as outlined by Levinson and Erikson, are reviewed. However, more than routine midlife developmental problems occur in most suicides. Some of the possible distinctive traits of midlife suicides (versus younger and older suicides) include: loss of spouse, years of heavy drinking, reaching the age of high depression risk, and occupational problems (including unemployment, inability to work, and retirement). Midlife suicide rates tend to be highest among white males, although female suicide rates peak in midlife. The paper concludes with a review of assessment and treatment issues related to a half-dozen high-risk midlife suicide types.     

Cross-national social ecology of intelligence and suicide prevalence: integration, refinement, and update of studies

This study integrates, refines, and updates previous findings pertaining to positive ecologic (population-level) associations between intelligence and suicide prevalence across nations by using corrected and revised national IQ estimates and, further, a quality-of-human-conditions index, both recently published by Lynn and Vanhanen. Across a global 85-nation sample of sex-specific total suicide rates and a Eurasian 48-nation sample of sex-specific elderly suicide rates, these were positively associated with updated national IQ estimates. The associations were stronger for the general population than for elderly persons, independent of the quality of human conditions, and notedly stronger in exponential fitting of suicide rates with national IQ than in linear fitting, thereby indicating that shifts or differences in national IQ correspond to proportional, not absolute, changes in suicide rates. Implications of these findings and the question of generalizability of such associations to the individual level are discussed.     

The Relationship Between General Population Suicide Rates and Educational Attainment: A Cross‐National Study

Suicides are associated with both high and low levels of intelligence and educational attainment in both individual‐level and aggregate‐level studies. A cross‐national study examining the relationship between general population suicide rates (y) and educational attainment (x) was undertaken with the a priori hypothesis that the relationship would be curvilinear and follow a U‐shaped curve with the quadratic equation Y = A + BX + CX², where A, B, and C are constants. Data on suicide rates and the Education Index (a proxy measure of educational attainment) were ascertained from the World Health Organization and the United Nations Web sites, respectively. The main finding was the predicted curvilinear relationship between general population suicide rates, in both sexes, and the Education Index fit the above quadratic equation. Given the cross‐sectional study design, a causal relationship cannot be assumed. The impact of educational attainment on general population suicide rates may occur through interaction with other factors, mediation of the effects of other factors, or by its effects being mediated by other factors, and require further study.     

Suicide after surgical treatment in patients with epilepsy: a meta-analytic investigation

Suicide is a major issue in surgically treated epileptic patients. A meta-analysis was performed comparing suicides in a sample of such patients and in the general population. The Index Medicus and the World Health Statistics Annual were searched to ascertain the suicide rates in the age groups indicated in the studies of epileptic patients for specific years and country. 11 studies were selected, comprising 2,425 patients, 24 of whom committed suicide. Data obtained for each study were processed together to calculate the mean number of suicides per 100,000 individuals with surgically treated epilepsy for each year. This meta-analysis shows that suicide in patients with epilepsy after surgical treatment is more frequent than in the general population. Results are discussed with particular attention to possible causative factors.     

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.