自杀方式与性别和年龄关系548例分析

目的分析国内5个城市地区采取不同自杀方式人群的性别和年龄特征。方法收集上海、金华、武汉、娄底、都匀城市地区警方处理的548例自杀案例,根据自杀方法将案件进行分类,研究各种自杀方法的人群年龄和性别特征,结果在各种自杀方式的年龄分析中,高坠和自缢的自杀者平均年龄最大(约55岁),溺水、自缢次之(约49岁)、口服毒物较为年轻(约45岁),而CO中毒自杀者平均年龄最小(约37岁)。在自杀方式的性别差异中,男性更多地出现了锐器自杀(52:24),自缢(67:33)和高坠(55:45),女性则在溺水自杀中占据多数(58:42)。结论每种自杀方式涉及到的人群的性别和年龄特征差异明显,CO中毒自杀的自杀者最为年轻;男性更倾向于用机械性损伤的方式来自杀。     

Correlates of law enforcement suicide in the United States: a comparison with Army and Firefighter suicides using data from the National Violent Death Reporting System

Law Enforcement (LE) officers are considered to be at elevated risk of suicide. This study explored variables associated with LE suicide and the extent they differentiated LE suicides from those within similar occupations considered at risk – Army and Firefighters. Using a public health database of violent deaths, the US National Violent Death Reporting System (NVDRS), the prevalence of and association between seven suicide variables (treatment for a mental health condition, Post Traumatic Stress disorder diagnosis, alcohol and substance abuse, job problems, intimate partner problems) and suicide within LE, Army and Firefighters was computed. Method of suicide and demographic characteristics were also identified. All of the suicide variables were associated with suicide in the three occupation groups. LE suicides were differentiated from Army and Firefighter suicides by being more strongly associated with job problems and suicide by females was more common. Implications for suicide prevention strategies within LE are discussed.     

Female suicides in Diyarbakir, Turkey

The aim of this study was to investigate the methods used and demographic data of women suicides by examining postmortem investigation and autopsy reports from the Branch of the Council of Forensic Medicine in Diyarbakir Province, Turkey, between 1996 and 2001. Fifty-eight percent (174/302) of suicides were females and 42% (128/302) were males. The suicide rates were similarly higher for females than for males (2.6 and 1.8 per 10,000 population, respectively). Over half of female suicides (56.3%) occurred in those under 20 years of age. The most common suicide method for women was hanging (32.2%), and for men was firearms (51.7%), but for women younger than 20 years the most frequent method was firearms. Among the female suicides, five (2.8%) were known to have attempted suicide at least once in the past. Twenty-nine women (16.7%) were documented to have any psychiatric illness. None of the women had a history of drug or alcohol abuse. A suicide note was found in only six cases (3.4%). The predominant suicide motive was family problems (in 32% or 56/174). The higher rate of suicide in females than in males, and the absolute female predominance in suicides in Diyarbakir, Turkey, are in contrast to most of the medical literature and statistical information about suicide rates by country, in which suicide rates are usually higher among males.     

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.     

Suicide in children and adolescents: a 10-year retrospective review

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.     

Complex suicides--a review of the literature

The term "complex suicide" stands for suicides committed by using more than one method. A distinction can be made between planned and unplanned complex suicides (primary/secondary combinations). In planned complex suicides 2 or more methods are applied simultaneously in order to make sure that death will occur even if one method fails. In unplanned complex suicides the mode of performance is changed after the first method chosen failed or was working too slow or proved to be too painful. In planned complex suicides typically two of the generally common methods of suicide (e.g. ingestion of medicines, hanging, use of firearms, drowning, fall from a height) are combined. But also unusual combinations have been described such as the simultaneous firing of two guns, self-immolation in combination with other suicide methods or shooting oneself while driving a car. In unplanned complex suicides self-inflicted injuries by sharp force, especially cuts of the wrists, are often found as the primary act of suicide. In some cases the suicide switches from cuts to stabs (mostly to the heart region). Other methods often used after the first phase of suicide are hanging and jump from a height. In the literature the use of up to 5 suicidal methods applied one after the other have been described.     

Factors related to suicide in New York state prisons

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.     

Suicidal Drug Overdoses in New Mexico: A 5‐year Retrospective Review

To better understand the changing toxicology trends in suicidal drug overdoses in the setting of an increased national trend of multidrug overdoses, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 2008 and 2012 to assess the drug type and current risk factors in suicide deaths. Information on demographics, circumstances, suicide risk factors, toxicology findings, and death certificates was collected and analyzed. Three hundred and forty‐two suicide cases of suicide overdoses were identified. Decedents were predominantly female (61.8%). Scene investigation revealed risk factors including suicide ideation (47.4%), previous suicide attempts (38%), and suicide note (38%). Psychiatric illness was present in 72% of cases, with depression being the most common illness. Chronic pain was seen in 27.2% of cases. Most deaths were attributed to multiple drugs (76%). Utilizing the toxicology information will assist in creating public awareness and provide a framework to support targeted efforts to attempt to prevent future suicides.     

Suicide and homicide away from home

In 1980, suicides in the United States that occurred outside the victim's home state were most often committed by young single or divorced men. Hanging was the most common means of suicide. Homicide victims who were killed outside their home state were usually male, black, divorced, young, and killed by unusual (other) means or by law-enforcement officers.     

Fatal firearm wounds: a retrospective study in Bari (Italy) between 1988 and 2003

Fatal gunshot injuries are routinely encountered by forensic pathologists practicing in Southern Italy. Bari, the capital city of the Italian region known as Apulia, is a leader with regard to the number of firearm deaths in Italy. This is mainly attributable to local organized crime groups which control a variety of illicit activities. This retrospective study analyzes autopsy data related to fatal firearm wounds, handled by the Institute of Legal Medicine [University of Bari], between 1988 and 2003. A total of 717 cases were selected and classified as follows: firearm homicides (634); suicides (82); and accidental death (1). A significant number of variables have been reviewed such as: month in which the violent event took place; the victims' nationalities; gender and age of victims; site and number of entrance wounds; weapon type used; and manner of death (i.e. homicide; suicide; accidental). Analysis has revealed a homicide versus suicide ratio of almost 8:1. Victims were mostly male with a lower mean age than in other similar studies. Homicides with multiple gunshot wounds were more common than ones with single entrance wounds. For example, in one case, 30 entrance wounds were identified in the murder of a gang boss. Four suicides with two entrance gunshot wounds were identified. Handguns were the most frequently used weapon in all groups (i.e. homicide, suicide, and accidental), with 7.65 mm and 9 mm being the most common calibres. This study revealed a very low incidence of suicide among females. Mental and other types of illness, as well as financial stress were the apparent motives which prompted most of the suicide victims. The homicide cases described were most often related to continual, ongoing fights among local criminal gangs (75%).     

Mortality in maximum security psychiatric hospital patients

Numerous studies have mentioned to the high percentage of violent deaths in prison psychiatric hospitals, with suicide being the principal cause. The aim of this study was to analyze the circumstances related with the deaths recorded in a high security institution. Postmortem reports on all the deaths at the Alicante Psychiatric Prison between 1984 and 1997 were studied (36 cases of unnatural death and 28 of natural death). Of the violent deaths recorded 34 (94.4%) were suicides. Demographic, clinical and interpersonal variables factors were registered. In the cases of suicides, the method used, the place of death, season, month and time of suicide were analyzed. In our study, 64.7% of suicides were schizophrenic and 32.4% had inflicted self-harm previously. We found a statistically significant association between the cause of death (natural, suicide or homicide) and age, 47.1% of suicides being between the ages of 18 and 30 and 29.4% between the ages of 30 and 45. Natural causes predominated in older subjects. The prison population studied showed grave negative traits, mental illness and criminal behavior having forced them to the very edge of society. Our results were compared with the death and suicide rates of the general Spanish population.     

Suicide behind bars: trends, inconsistencies, and practical implications

The results of two comprehensive approaches are compared: the nationwide surveys of suicides in U.S. jails by Hayes and the international meta-analyses of suicides in jails and prisons by Fazel et al. Factors are classified as demographic, situational, clinical, and methodical. More than 50% of U.S. jail suicide victims were men, white, unmarried, under 28 years of age, charged with minor or drug-related offenses, and intoxicated with drugs or alcohol. Suicides significantly occurred in isolation. Suicide victims in the international study were significantly (p < 0.001) men, white, married, pretrial, and charged with or convicted of violent offenses. Psychiatric diagnosis, alcohol abuse, taking psychotropic medication, and suicidal ideation were also positively correlated in the international study, but suicide victims were distributed more evenly over age-groups. Results of other studies illustrate the near universality of some findings. Three theories of suicide are briefly discussed.     

Youth suicide in New Mexico: a 26-year retrospective review

Although suicidal behavior in children and adolescents is a major public health problem, large-scale research on suicide in this population is uncommon. In this study, we reviewed autopsy and field reports for all pediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005. The age-adjusted suicide rate was 4.8 per 100,000. Psychologic stressors and parasuicidal behavior were identified in some cases. Seventy-six percent of suicides occurred in the victim's home or yard, and 25% left a suicide note. In 26% of cases, alcohol or other drugs were detected in postmortem. Gunshot wound was the most common method overall (58%), followed by hanging (30%). Although the age-adjusted suicide rate is higher in New Mexico than nationally, the trends in the population are similar. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of child and adolescent death.     

Factors in prison suicide: one year study in Texas.

The goal of the study was to examine psychopathology and stressors suffered by suicide victims, and to describe the characteristics of the suicides in the Texas Department of Criminal Justice between June of 1996 to June of 1997. Data on 25 completed suicides were collected from the records department. Results: The authors identified 60% of the suicide victims with a history of psychiatric disorders. Seventy-six percent had been diagnosed with psychiatric disorders while incarcerated. The most frequent psychiatric disorders were mood disorders (64%), psychotic disorders (44%), personality disorders (56%), and comorbidity with a history of presentencing alcohol and drug abuse was common. Most of the victims experienced chronic and/or acute stressors of acute trauma, disrupted relationship, sentence hearing, and/or medical condition. We concluded that important factors associated with increased risk of prison suicide include psychiatric disorders, comorbid substance abuse, a history of suicide attempt, and chronic and/or acute stressors.     

Presence of alcohol in suicide victims

A number of studies have established a strong connection between acute inebriation, alcohol addiction and suicides, as the last act of alcoholism or an act of desperation in an alcoholic's family, an act of escape from restraints in state of depression or as a way of self-destruction.In recent years in average 600 people per year committed suicide. Slovenia is a country with extremely high and variable suicide tendencies and harmful alcohol use levels, as well as a high level of alcohol-related troubles.The aim of our research was to ascertain some typical features, especially those connected to the inebriation of suicide victims from a wider Ljubljana region. Autopsies were carried out on the victims in the period between 1995 and 1999.There were 508 (31.2%) suicides among all the analyzed violent deaths; 73.2% of them were men. The average age of the victims was 46.5 years. Most suicides were committed at home (50.0%). 25.4% were completely sober in the moment of the act, while in all other cases inebriation was established, the average value being 9.57 g/kg. Men were drunk in 87.1% of cases, women only in 12.9% and the given alcohol levels were substantially higher with men (0.65:0.26 g/kg). The share of inebriated persons decreases with age—reaching its peak in the 35–54 age group. Regarding the method, the predominant ones are intoxication and the use of firearms, which is a typical way of committing suicide among men, while women rather choose jumping from great heights and drowning.Alcohol was present in as many as 55.7% of suicides with intoxication and in 68.8% of all suicides committed by using firearms, while the highest alcohol levels were found in those who died from cutting their veins (2.01 g/kg).Based on this and on other research, more effort should be focused on alcohol abuse prevention, making all people aware of the consequences of alcohol abuse, the possibilities of treatment and their availability as well as possible co-morbid depressions. Simultaneously, due to an established link, the national alcohol policy and strategy for prevention of suicides should be professionally harmonized.     

Why Do People Hang Themselves on Trees? An Evaluation of Suicidal Hangings on Trees in Konya,Turkey, between 2001 and 2008

Hanging is the most common method of suicide in the world, and many public places offer a means or opportunity to carry out the activity. Of 4,452 death examinations and autopsies, there were 378 (8.5%) suicides and suicide method was hanging in 185 (48.9%) cases. In 20 of these (10.8%), the suspension point was the branch of a tree. The incident location was the garden of the victim's house in nine cases, the woodlands in seven cases. The suicides were attributed to psychiatric disorders in nine cases, economic problems in six cases, and family problems in five cases. It is concluded that hanging on a tree as a suicide method is often committed by males and the underlying motive may be different in suicidal hangings on trees occurring at daytime and night. For preventional purposes, the reporting of such suicides in public places by the media may be restricted by local authorities.     

Suffocation using plastic bags: a retrospective study of suicides in Ontario, Canada

One hundred and ten cases of suicidal suffocation using a plastic bag were identified in the files of the Office of the Chief Coroner of Ontario, Canada, between 1993 and 1997. The records were reviewed to determine the demographic characteristics of this group compared with all cases of suicide in Ontario, the scene information, autopsy findings and toxicology results. Most suicides occurred in people over 60 years of age, with older women making up a considerable proportion of cases as compared with other methods of suicide. In 40% of cases the deceased was suffering from a serious illness. Autopsy findings were usually minimal, with facial, conjunctival and visceral petechiae present in a minority of cases. One or more drugs were detected in the blood in 92.6% of cases where toxicologic testing was performed. Benzodiazepines, diphenhydramine and antidepressants were the most common drugs found, with diphenhydramine the most common drug present at an elevated concentration. Information at the scene from "right to die" societies was uncommon. One quarter of decedents took additional measures, besides the use of drugs or alcohol, to ensure the rapidity, certainty or comfort of their death. This study further elucidates the characteristics of this uncommon method of suicide. It emphasizes additional scene findings, such as the presence of dust masks, physical restraints and modification of the plastic bag that may be of use to death investigators in determining the correct manner of death.     

Suicides in hospitals of Vienna (author's transl)]

An analysis of the autopsies ordered by the Viennese Forensic and Health Authorities between 1967 and 1976 has shown that 2.3% of all suicides were committed in hospitals. Two thirds of the 77 examined cases were carried out by males. Thirty-five patients were in stationary psychiatric treatment; their average age was 50.7 years. In all other kinds of hospitals 42 (mostly male) patients committed suicide at an average age of 65.3 years. Preferred methods of performance were jump and fall from height (44.1%) and hanging (40.3%). Rare methods used were one case of abdominal incisions (harakiri), one self-strangulation, and one case of suffociation in plastic bags. The act was usually accomplished early in the morning or in the late afternoon. Among the suicidal patients who were hospitalized because of organic diseases those with malignant neoplasms [18] and cardiovascular diseases [12] were predominant. Also taking the suicides outside hospitals into consideration the numerical ratio between natural deaths due to cancer and the suicides of cancer patients is about 1:1,000. Amont the suicides in psychiatric institutions schizophrenics [11] and endogenous depressives [7] were the most numerous. In 4 cases the suicide was preceded by acts of injury or homicide.     

Elderly suicide: a 10-year retrospective study

The suicide rate in the 65-year and older age group has been increasing since 1980. The elderly attempt suicide less often than younger people but are successful more often. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical Examiners' Office at the Medical University of South Carolina (Charleston, SC) from January 1988 through December 1997. The cases of suicide in victims 65 years and older totaled 78, accounting for 11.5% of all suicides reviewed. Of these 78 cases, 41% were autopsied and 59% were externally examined. All of the cases were initially analyzed as to age, race, sex, and method of suicide. Files also were reviewed to determine time of year of the suicide, toxicology results, psychiatric history, social history, medical history, and whether a suicide note was left. The ages of these suicide victims ranged from 65 to 94 years; men comprised 85% of the victims, and whites, 94%. The male-to-female and white-to-black ratios were 6:1 and 15: 1, respectively. The average age of the victim was 73 years. Gunshot wound was the most common method of suicide, accounting for 80.7% of the cases. Other methods included overdose (6.4%), hanging (3.8%), fall from height (2.6%), incised wounds (2.6%), drowning (2.6%), and carbon monoxide poisoning (1.3%).