The most common method of suicide in Tehran 2000-2004: implications for prevention

The likelihood of completing suicide depends to some extent on knowledge of effective means and also on the availability and/or acceptability of such methods. Since studying suicide methods may have an implication for prevention, the focus of this study was on the most favored method of suicide in Tehran, Iran. The study uses confirmed suicide data provided by the Beheshet Zahra Organization (BZO), which gathers all mortality data within Tehran and enters them into a computerized database, from which the relevant information for all the recorded suicide cases during the year 2000 to 2004 were obtained and analyzed. There were 703 cases of suicide (632 males and 71 females) in the BZO database, with a sex ratio of 8.9. The mean (standard deviation) of age at suicide for those who chose hanging and for those who have chosen other methods of suicide were 33.93 (14.2) and 34.60 (13.4) years, respectively. Hanging was the method favored by 572 (85.9%) of cases. Use of hanging was higher in females (61, 85.9%) than in males (511, 80.9%), and higher among the married (304, 53.6%) than among singles (268, 46.4%). The high proportion of persons using hanging as a method of suicide in Tehran may reflect the fact that this method is more acceptable and/or easily available and/or less likely to be misclassified as accidental or undetermined death. The prevention of such suicides is extremely difficult in the general population. Therefore, it is suggested that, to prevent suicide by hangings, the authorities should focus on the causal factors of suicide rather than on the acceptability and/or the availability of this method.     

Understanding self-harm and suicide websites: a qualitative interview study of young adult website users

Self-harm and suicide websites have been heavily criticized both in the literature and the wider media, despite the fact that very little is known about them. To date, no study has interviewed users of these sites about them. This qualitative study aims to explore the accounts of young adults who engage in self-harming and suicidal behaviors and use websites dedicated to these issues, in order to develop a broader understanding of these websites and to identify potential implications for future research. In-depth interviews were conducted via e-mail with 10 participants, who were recruited directly from self-harm and suicide websites. Using discourse analysis, we identified three main ways in which participants wrote about the sites. They constructed them as sources of empathy and understanding, as communities, and as a way of coping with social and psychological distress. These discourses gave users access to important, socially valued identities, such as being understood, belonging to a community and coping with their problems. If health professionals and researchers hope to understand people who use self-harm and suicide websites, and engage them in their services, they must take a more balanced view and not focus solely on the possible risks associated with using such sites.     

Suicide in developing countries (2): risk factors

The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.     

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.     

Suicide risk in patients with somatization disorder

The aim of the study was to assess suicide risk in psychiatric outpatients with and without somatization disorder. A total sample of 120 psychiatric outpatients was used in the study, 29 of whom met diagnostic criteria for somatization disorder. The results indicated that somatization disorder was significantly associated with suicide attempts even when the effects of both a comorbid major depressive disorder and a comorbid personality disorder were statistically controlled for. The results suggest that, although a patient meets the criteria for a principal diagnosis of major depressive disorder and/or a personality disorder, it is still of significant importance to decide whether or not the patient also meets the criteria for a somatization disorder in order to more optimally assess suicide risk. The findings highlight the fact that the potential for suicide in patients with somatization disorder should not be overlooked when a diagnosable depressive disorder or personality disorder is not present.     

A suicide prevention strategy for England

Over the last decade an increasing number of countries have established national strategies for suicide prevention. In the autumn of 2002 the suicide prevention strategy for England was presented to the general public, introducing what could be called a second generation of national programs for suicide prevention. This strategy uses evidence-based criteria for its priorities more systematically than before. Furthermore, it has put an increased emphasis on goals being specific, preventive measures being practical, and the preventive potential being visible. Other guiding principles for this strategy are that suicide preventive measures and initiatives should be open to monitoring and evaluation, and that revisions and updates of the national strategy should be made regularly--thus constituting an evolving strategy. This paper examines the content of the new national strategy for suicide prevention in England and what new contributions to the field it may make.     

Sati: a type of nonpsychiatric suicide

Sati as an act of ritual suicide has been reported from the Indian subcontinent, especially among the Hindus, for several centuries. Although legally proscribed, these acts occur even now in modern India. The principle behind such acts has been put forward as the principle of good wife. There is little evidence to suggest that women who commit this act suffer from a formal mental illness. Cultural factors and gender role expectations play a significant role in the act and its consequences. Using recent examples, this paper illustrates the cultural factors, which may be seen as contributing to the act of suicide. Other factors embedded in the act also emphasize that not all suicides have underlying psychiatric disorders and clinicians must take social causation into account while preparing any prevention strategies.     

Adolescent suicide myths in the United States

In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.     

Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature

The prediction of suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. This paper provides an overview of the inpatient suicide literature to date focusing on two particularly salient themes: Long term and short term prediction of suicide. Since the concept of short-term suicide risk dominates clinical practice, issues in relation to dynamic risk factors are emphasized.     

Suicide after deployment in UN peacekeeping missions--a Danish pilot study

This pilot study looks at the frequency of suicide among Danish soldiers who took part in the UN mandated forces (UNMF) during the 1990's. In a contingent of nearly 4000 Danish UN soldiers four suicides were documented, two of whom committed suicide less than one month before deployment and two who committed suicide within a year after discharge from mission. Contributing factors, prevention strategies, and implications for future research are discussed.     

The Making of a Martyr: Chechen Suicide Terrorism

Beginning in June of 2000 Chechen terrorists have carried out twenty-eight acts of suicide terrorism acts including two mass hostage taking operations combined with suicide terrorism (Beslan and Nord Ost). This paper reports the findings from psychological autopsies (interviews with close family members and friends) of thirty-four (out of 112 total) of these human bombers as well as augmenting them with material from hostage interviews from Beslan and Nord-Ost. The authors analyze the phenomena on the levels of the organization, individual, society and in terms of ideology and compare findings from other arenas also involving suicide terrorism. The main findings are that a lethal mix occurs when individuals in Chechnya are vulnerable to self recruitment into suicide terrorism due to traumatic experiences and feeling a duty to revenge and this vulnerability is combined with exposure to groups that recruit and equip suicide terrorists with both an ideology and the means to explode themselves. The ideology supporting Chechen suicide terrorism is very similar to the global jihadist ideology but remains more nationalist in its goals. It functions for the bombers much like short lived psychological first aid—answering their posttraumatic concerns in a way that shortly leads to their deaths. Unlike the Palestinian case, there is little social support for suicide terrorism in Chechnya.     

Some problems of research on the association between blood types and suicide mortality: comment on Lester (2004)

This is a comment on the ecological finding of a negative association of national suicide rate and national proportion of people with Type O blood (Lester, 2004). Current knowledge on this topic is reviewed and several problems, limitations, and discrepancies within this research line are noted. Specifically, it is suggested that (1) this association appears to have been subject to attenuation recently; (2) available ecological evidence on this association is contradictory to both individual-level findings on the same topic and similar ecological-level findings pertaining to personality-related risk factors and antecedents of suicide; (3) a negative association of one of the four ABO phenotypes with suicide mortality does not help single out phenotypes with possibly increased suicide risk; and (4) genetic suicide risk factors may well be associated with other ABO phenotypes than Type O and may further coincide with other blood polymorphisms than the ABO system.     

Beyond risk theory: suicidal behavior in its social and epidemiological context

The effect of exposure to risk factors for suicidal behavior varies from place to place and from period to period. This may be due to contextual influences, which arise if individuals' suicide risk depends not only on their personal exposure to risk or protective factors, but also on how these are distributed in their social, cultural, economic, or even physical environments. There has been relatively little explicit attention in suicide research for such contextual influences even though they are an important component of the cross-level bias, which can arise when aggregate level associations are assumed to also apply in individuals and vice versa. Contextual effects are conceptually related to the issues of social selection vs. causation, population density, and network effects. Because of a lack of prospective multilevel research, it is unclear exactly which mechanisms underlie the phenomenon that the distribution of risk factors in an individual's context may affect their suicide risk above and beyond their personal exposure. A number of mechanisms, like deviancy amplification, formalization of restraints, and buffering effects of social support are proposed. Contextual effects may result in a concentration of suicide risk in persons when the risk factors they are exposed to become rare--whether spontaneously or through focused prevention. This has important but mostly overlooked implications for population-based prevention strategies.     

Remarks by Mary McAleese, President of Ireland made at the International Association of Suicide Prevention XXIV Biennial Conference, August 31, 2007, Irish National Events Centre, Killarney, Co. Kerry, Ireland

Reducing suicide rates requires a collective, concerted effort from all groups in society: health, social services, other professionals, communities and community leaders, voluntary and statutory agencies and organizations, parents, friends, neighbors, and individuals. It also requires the careful nurturing of a culture in which people in psychological distress don't hesitate to seek help from family, friends, health professionals and community leaders, a culture that recognizes the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices; in short, a sensitive culture that cherishes human courtesy and takes responsibility for our own mental health and the mental health of others. Suicide occurs in many diverse contexts but there are recurring patterns and elements that research is revealing to us. The more we are learning, the better we are able to devise strategies and take action. We already know, for example, that alcohol abuse plays a very significant role in suicide and features prominently in youth suicide. Research has also established that cannabis increases the risk of depression and psychosis and that it reduces normal inhibitions against suicide. Since marijuana is the illegal drug most used by those under25 years of age, a critical factor in suicide prevention must be to inform young people as to its danger and counter the erroneous impression that it is a benign substance. We know that bullying sometimes features in the story of suicide. Our young people need to know just how damaging, just how unacceptable, bullying is. Education and access to support structures - whether at work, school, or home - are an essential part of protecting the victim of bullying not just from the bully but from their own downward spiral into suicidal thoughts. A less discussed but nonetheless important issue worth raising is the issue of dealing with sexual identity. Although Ireland is making considerable progress in developing a culture of genuine equality, recognition, and acceptance of gay men and women, there is still an undercurrent of both bias and hostility which young gay people must find deeply hurtful and inhibiting. For them, homosexuality is a discovery, not a decision, and for many it is a discovery which is made against a backdrop where, within their immediate circle of family and friends as well as the wider society, they have long encountered antigay attitudes which will do little to help them deal openly and healthily with their own sexuality.     

Male and Female Suicide Bombers: Different Sexes,Different Reasons?

This article analyzes the motivations and recruitment of female suicide terrorists. Biographical accounts of 30 female and 30 male suicide terrorists were coded for method of recruitment, motivation for attack, and outcome of attack. A log-linear analysis found that female suicide terrorists were motivated more by Personal events, whereas males were motivated more by Religious/nationalistic factors. Females were equally likely as males to be recruited through peer influence, exploitation, or self promotion, whereas males were more likely to be recruited as a result of religious persuasion. The results highlight the need for continued research into female terrorism.     

Suicide in Japan: present condition and prevention measures

This article introduces the reader to present conditions and suicide prevention measures in Japan. The suicide rate has increased gradually since the early 1990s, reaching a postwar peak in 1998. The number of suicides has remained at about 30,000 every year since 1998. Middle-aged (55-59 years) and elderly men have especially high suicide rates. In 2002, The Council of Learned People on Measures Against Suicides (organized by the Japanese Ministry of Health, Labor, and Welfare) released its report on national suicide prevention strategies. Although national suicide prevention strategies have just begun to be established, some prefectures or regions have undertaken unique suicide prevention measures.     

County council politicians' attitudes toward suicide and suicide prevention: a qualitative cross-cultural study

The purpose of the present study was to compare county council politicians' attitudes toward suicide and suicide prevention in five European countries. A questionnaire was distributed and here the responses to the open-ended questions are analyzed qualitatively. Considerable differences were found in what the politicians in the five countries believed to be the most important causes of suicide and how suicide can be prevented. There were also differences in to what degree the politicians revealed a judgmental attitude toward suicide, which seemed to be related to the magnitude of the problem in the respective countries. A certain implicit inconsistency in the logic directing the politicians' responses was found when their views on causes to suicide and suicide prevention strategies were compared. The responses indicate a need for increased consciousness and knowledge about suicide and suicide prevention among politicians in all the five countries. This is important since they are responsible for initiating and funding suicide preventive efforts.     

Suicide in Bahrain in the last decade

A combination of social, legal, and religious factors make reporting of suicide difficult in Bahrain, an Islamic country. Limited available data indicates a very low incidence rate of 3 per 100,000. The objective of the present study was to describe the pattern of suicide in Bahrain during a 10-year period. The registered suicide cases (N = 304) at the Ministry of Interior for the 10-year period from 1995 to 2004 were reviewed and analyzed. The mean suicide rate was 0.6 per 100,000 for the Bahraini nationals and 12.6 per 100,000 for the non-Bahrainis with and 17.7 per 100,000 for the Indian migrants. Men were six times more likely than women to commit suicide. The majority of the subjects were under 35 years of age with financial domestic problems being the most common reason reported in the record and hanging the mostly commonly used mode of suicide (92.8%). The suicide rate for the Bahraini population remains low compared to other countries. The higher rate of suicide among Indians merits further investigation. Moreover, more research is needed on the epidemiology of suicide risk factors in ethnic groups for further prevention and intervention.     

Season and suicide: recent findings from Italy

Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological, and sociological research, and the effects of seasonal factors on suicidal behavior have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have generally favored interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are a unitary phenomenon, not influenced by age, gender, or circumstances of the act. In particular, the seasonal occurrence of suicides has been found to differ significantly between the young and the elderly, and differences have also been found between male and female cycles of occurrence. Suicides using violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods (such as drug or gas poisoning), possibly reflecting the greater impulsive component involved in the choice of a violent lethal means. In this paper, findings from Italy are used to illustrate the clinical implications of studies into the topic of season and suicide, with the aim of developing more effective preventative strategies.