Frequency and Clinical Features of Patients who Attempted Suicide by Hara‐Kiri in Japan

Hara‐kiri is a unique Japanese custom, primarily stemming from the manners and customs that a samurai held. The aim of the present study was to investigate the clinical features of individuals who attempted suicide by hara‐kiri. We enrolled 647 patients who had attempted suicide. Clinical features were compared between those who had employed hara‐kiri and those who had used other methods. 25 of the 647 subjects had attempted suicide by hara‐kiri. The ratio of men to women and the proportion of patients with mood disorders were significantly higher in the hara‐kiri group than in the other methods group. The average length of stay in either the hospital or in the intensive care unit was also longer in the hara‐kiri group than in the other methods group. Hara‐kiri is an original Japanese method of attempting suicide, and suicide attempts by hara‐kiri may be aimed at maintaining a reputation or taking responsibility.     

Increased risk of suicide with exposure to pesticides in an intensive agricultural area. A 12-year retrospective study

Several reports have suggested that exposure to agricultural pesticides (mainly chronic exposure to organophosphates) produces depression, and depression is a major risk factor for suicide. A retrospective epidemiological study of 251 suicide cases was undertaken to explore the possible relationship between the high suicide rates in an intensive agricultural area, and a specific group of population at risk, namely farmers with chronic exposure to pesticides, who are at risk to develop mood disorders (mainly depression). Our data show that the suicide rate in that area is significantly higher than the suicide rates from other geographic areas with very similar socioeconomic and demographic features. In addition, the mortality from suicide in this population (farmers) does differ significantly from that of the rest of the population.     

Psychological profile of sex offenders using weapons in their crimes

Abstract

A sample of 1533 sex offenders was examined for clinical characteristics associated with weapon use in their crimes. A total of 24.9% used weapons, most often knives (50.1%), with 13.6% using multiple weapons. Weapon-users were a very disturbed group, who showed a significantly higher prevalence than non-users of psychoses, suicide attempts, alcoholism, drug addiction and abuse, personality disorders, psychopathy, attention deficit hyperactivity disorder, cognitive impairment and violent criminal histories. The weapon-users recidivated more often than non-users and appeared in court on 8.7 separate occasions compared to 2.9 for non-users in an average follow-up of 21.5 years. The best predictors of weapon use were total violent offence convictions, sadism diagnoses and adult versus child victims. The importance of examining weapon use in assessing sex offenders is discussed.     

Child and adolescent suicide in a large, urban area: psychological, demographic, and situational factors.

We examined all completed suicides by children and adolescents in Los Angeles County who died during 1996 and 1997. There were 46 subjects, aged 11 through 16. The majority of the decedents were males and over age 14. The predominant racial group was Hispanic. There was an almost even split between firearms and hanging as the means of death. Females had a statistically significantly higher rate of prior suicide attempts than males. Over one-third left a suicide note, almost one-half were noted to be depressed, and 22% tested positive for alcohol or illicit drugs. Less than one-quarter were in mental health treatment. Eighty-seven percent had difficulty transitioning to or during adolescence; e.g., problems at home, legal and school difficulties, and relationship losses. These findings are discussed in terms of Eriksonian developmental theory. We offer recommendations for intervention and prevention of suicide.     

Potentially dangerous behavior in the mentally ill: attitudes of journalists and medical students toward compulsory admission

Compulsory admission is a critical measure that may lead to stigmatization of patients. The authors investigated what medical students and journalists consider legitimate conditions for compulsory admission. The most frequently quoted conditions in both groups were violent attempts against others. About one third of each group considered continuous neglect as a reason. Students significantly more often than journalists advocated for civil commitment in the case of suicide attempts and violent attempts. Medical students with personal contact with mentally disordered persons advocated significantly more often for coercive measures in the case of suicide attempts. Comparing journalists and medical students having personal contact with mentally disordered persons revealed that medical students significantly more often supported commitment. Journalists displayed a more liberal attitude toward the mentally ill than did medical students.     

Deliberate self-harm and suicide attempt in custody: distinguishing features in male inmates' self-injurious behavior

Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of "serious" vs. "non-serious" and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of "low seriousness" (i.e. low lethality and low suicidal intent) and of "high seriousness". Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.     

Trouble in Mayberry: A national analysis of suicides and attempts in small jails

Despite the fact that there are approximately 1,775 American jails of 99 beds or less, little is known about how these jails function, or the challenges that they confront. This study examined the problem of suicides and attempted suicides in small jails, finding that the prevalence of these incidents is two to five times greater than in their larger counterparts. Net of other factors, jails that had higher rates of admissions, as well as overcrowded facilities had a positive relationship with suicide attempts. We also found that jails that reported higher concentrations of special needs inmates were significantly associated with attempts. Specifically, facilities that had higher levels of long-term inmates were positively associated with suicide attempts. While almost one-fifth of small jails did not use formal suicide assessments at admission, and only slightly more than one-half of these facilities provided annual suicide training to jail officers, these factors were not significantly associated with suicide attempts in 2004. Implications for future research and practice are outlined.     

Various mechanisms of death and their possible association with alcoholism

Alcoholics who died because they were run over by trains, by precipitation, or were smoking in bed, were compared with a group of controls. A higher number of alcoholics were run over by trains, the manner of death most often being suicide. There was a significantly higher number of controls who fell from a height. The manner of death in the group ‘smoking in bed’ was more often accidental and occurred more frequently in alcoholics. Preventive measures are suggested.     

The suicide mortality rates between 1997-1998 and 2000-2001 in Nantou County of Taiwan following the earthquake of September 21 in 1999.

The paper aims to show the different suicide mortality rate between 1997-1998 and 2000-2001 in Nantou County of Taiwan with earthquake on September 21 (often referred to as the "9-21 earthquake") in 1999. In additional, it also identifies the preventive strategies for the high-risk suicide population. The age-standardized mortality rates for suicide in Nantou County were calculated for the years 1997-1998 and 2000-2001. The suicide standardized mortality ratio (SMR for townships in Nantou were calculated by "type of township" as the standard rate). There is a statistically significant difference in male suicide rates for the years prior to the earthquake (1997-1998) when pooled and compared to the suicide rates for the years after the earthquake (2000-2001). The rate for four age groups (under 25, 25-44, 45-64, 65 and above) all increased, yet all but one (the group of age 45-64) was not statistically significant. The male SMR has slightly increased after the 9-21 earthquake. Yet there are no statistical significances in most townships, except in Kaohsiung and Puli after the 9-21 earthquake. The Kaohsiung SMRs were 1.36 (95% CI: 0.54-2.80) before the earthquake (1997-1998) and 2.01 (95% CI: 1.04-3.52) after the earthquake (2000-2001). The SMRs before and after the earthquake in the Puli Township were 1.51 (95% CI: 0.95-2.29) to 1.56 (95% CI: 1.03-2.27). This study suggests that monitoring high-risk population, especially males or 45-64 years of age who experienced the highest statistically significant suicide rate in this study. The study provides support for providing both the psychological restoration program and, to the extent feasible, financial support for the unemployed as useful public health strategies for suicide prevention in Taiwan.     

The Suicide Mortality Rates between 1997–1998 and 2000–2001 in Nantou County of Taiwan Following the Earthquake of September 21 in 1999

Abstract:  The paper aims to show the different suicide mortality rate between 1997–1998 and 2000–2001 in Nantou County of Taiwan with earthquake on September 21 (often referred to as the "9-21 earthquake") in 1999. In additional, it also identifies the preventive strategies for the high-risk suicide population. The age-standardized mortality rates for suicide in Nantou County were calculated for the years 1997–1998 and 2000–2001. The suicide standardized mortality ratio (SMR for townships in Nantou were calculated by "type of township" as the standard rate). There is a statistically significant difference in male suicide rates for the years prior to the earthquake (1997–1998) when pooled and compared to the suicide rates for the years after the earthquake (2000–2001). The rate for four age groups (under 25, 25–44, 45–64, 65 and above) all increased, yet all but one (the group of age 45–64) was not statistically significant. The male SMR has slightly increased after the 9-21 earthquake. Yet there are no statistical significances in most townships, except in Kaohsiung and Puli after the 9-21 earthquake. The Kaohsiung SMRs were 1.36 (95% CI: 0.54–2.80) before the earthquake (1997–1998) and 2.01 (95% CI: 1.04–3.52) after the earthquake (2000–2001). The SMRs before and after the earthquake in the Puli Township were 1.51 (95% CI: 0.95–2.29) to 1.56 (95% CI: 1.03–2.27). This study suggests that monitoring high-risk population, especially males or 45–64 years of age who experienced the highest statistically significant suicide rate in this study. The study provides support for providing both the psychological restoration program and, to the extent feasible, financial support for the unemployed as useful public health strategies for suicide prevention in Taiwan.     

Childhood Adversities and Suicide Attempts: A Retrospective Study

The aim of the study was to assess the association among various childhood adversities and suicide attempts. A total of 575 patients of a psychosomatic clinic and general practitioners were examined by use of a structured interview. Seventeen percent of the sample reported a suicide attempt in the past. In particular, two forms of early violence (i.e., sexual abuse and harsh physical punishment) were associated with an increased risk for suicide attempts. In addition, financial hardship was associated with an increased risk for suicide attempts. Parental separation or divorce, and physical arguments between parents, increased the risk only in a bivariate analysis; after controlling for other adversities, no association with suicide attempts remained. Suicide attempts can be considered as an act of violence against oneself; they are associated with early experiences of sexual and physical violence.     

The Relationship between Homelessness and Behavior Problems among Youth in North Texas: a Brief Report

This study sought to examine the relationship between homelessness and behavior problems among a community-based sample of youth in North Texas. Data were obtained from a cross-sectional, probability sample of households and a targeted sample of homeless families in Dallas, Texas, with children older than 5 years old (N?=?5232). Parents were asked to report five behavior problems on behalf of their children including arrest or trouble with police, academic problems, behavior problems at school, suspension, and suicide attempts. Logistic and negative binomial regression procedures were used to examine the relationship between homelessness and behavior problems. Youth exposed to homelessness were 36% (OR?=?1.63; 95% CI 1.00–1.85) more likely to exhibit any kind of behavior problems than youth who had never experienced homelessness. Homeless youth had 5.51 times the odds of arrest (95% CI 2.60–11.68), 1.74 times the odds of academic problems (95% CI 1.24–2.43), and more than 3 times the odds of suicide attempts (95% CI 1.46, 7.61) than youth who had never been homeless. Homelessness was associated with higher rates of problem behavior, including arrests, academic problems, and suicide attempts. Because homeless youth are commonly enrolled in school and present at health care clinics and emergency departments, clinics and schools may aid in the identification of homeless youth, as well as referral to care. In this way, clinicians may help reduce the burden of behavioral problems that disproportionately affect homeless youth.     

National study comparing the characteristics of patients diagnosed with schizophrenia who committed homicide vs. those who died by suicide

Associations between serious mental disorder and violence are well-documented, but there is little epidemiological evidence linking these disorders and homicide risk. The reported study compares socio-demographic and clinical characteristics of people diagnosed with schizophrenia who committed homicide vs. those who died by suicide. The study is a national case series of male patients in England & Wales diagnosed with schizophrenia and convicted of homicide during 1997–2012 (n = 168), and a randomly selected comparison group of male patients with schizophrenia who died by suicide and who were matched to the homicide case series by age (n = 777). There are different patterns of behaviour in people with schizophrenia preceding homicide and suicide. Homicide perpetrators have frequently disengaged with services whilst patients who die by suicide are often in recent contact. This is important knowledge for clinical services as it indicates a different preventive emphasis despite the existence of other shared characteristics.     

Evaluation of Postmortem Cerebrospinal Fluid S100B Protein and Serotonin Levels: Comparison of Suicidal Versus Nonsuicidal Deaths in Konya,Turkey

Although suicide is a preventable public health problem, objective assays for suicide risk are limited. In this study, it was aimed to determine levels of S100B protein and serotonin as a marker for risk of suicide. S100B protein and serotonin levels were investigated with ELISA method in the cerebrospinal fluid (CSF) in medicolegal autopsy cases, including those of suicide cases (n = 32) and nonsuicide cases (n = 56). The CSF S100B levels were higher (9.3 ± 2.9 ng/mL vs. 5.4 ± 2.0 ng/mL), and serotonin levels were lower (10.4 ± 4.9 ng/mL vs. 19.0 ± 5.7 ng/mL) in suicide group than nonsuicide group (p < 0.05). There was no correlation between S100B protein and serotonin levels with gender, age groups, postmortem interval, and cause of death. It is concluded that both S100B protein and serotonin in CSF may be useful for determination of suicide risk.     

Nicotine and cotinine levels in body fluids of smokers who committed suicide

Cigarette smoking is associated with a higher risk for suicide. The present study was conducted on the hypothesis that suicide smokers show higher nicotine and cotinine levels in blood and urine than non-suicide smokers. We determined nicotine and cotinine levels in blood and urine of 87 deceased individuals (18 suicides and 69 non-suicides) by gas chromatography. The smoking rate was 77.8% for individuals who committed suicide and 42.0% for those who did not commit suicide. Average nicotine and cotinine levels in blood were significantly higher in the suicide smokers than in the non-suicide smokers (nicotine: 93.2+/-46.6 ng/ml versus 25.8+/-14.4 ng/ml, p<0.0001 and cotinine: 378+/-235 ng/ml versus 201+/-137 ng/ml, p<0.005). Average levels of urinary nicotine and cotinine were also significantly higher in the suicide smokers than in the non-suicide smokers (nicotine: 1980+/-2210 ng/ml versus 394+/-376 ng/ml, p<0.005 and cotinine: 1170+/-1330 ng/ml versus 414+/-290 ng/ml, p<0.05). Twenty-six decedents were intoxicated with alcohol, and they included 7 suicides (7 smokers) and 19 non-suicides (15 smokers). Our data suggest that cigarette smokers who commit suicide smoke more heavily than other cigarette smokers.     

Questioning the psycho-socio-cultural factors that contribute to the cases of suicide attempts: an investigation

Suicide attempts can be described to include all actions taken by an individual to end their life as a result of acute desperation. In parallel with the changes in the make-up of human societies both globally and in this country in recent years, suicide attempts are receiving attention in ever increasing proportions. The current study is aimed at investigating the psycho-socio-cultural factors that contribute to the known cases of suicide attempts. The study included 116 cases admitted to the Emergency Internal Medicine and Surgery Units of the University of Istanbul, Faculty of Medicine Hospital between 1 December 1998 and 31 May 1999. In only 47 cases, a 30-point questionnaire was used in several face-to-face interviews with the patients following the preparation of a clinical case study. In establishing the socio-demographic, socio-cultural and socio-economic attributes of each individual case, a range of contributing effective factors is questioned. Including the specific reasons for each suicide attempt, the emotional state of the individual prior to the suicide attempt, the type of suicide action chosen and reasons for this selection, immediate family structure, personal psychiatric antecedent, substance abuse. The results of our investigations are compared with the existing literature in a multi-faceted discussion.     

Differences among sexually abused and nonabused youth living with HIV

Risk behaviors were compared between sexually abused and nonabused youth living with HIV (YLH). Abused YLH were significantly more likely to have attempted suicide, to have been admitted into an alcohol and/or drug treatment program, and to have engaged in crack cocaine use than were nonabused YLH and had a greater number of sexual partners. A significantly higher proportion of abused YLH had been incarcerated in contrast to nonabused youth. There were also significantly greater conduct problems among abused YLH. Finally, abused YLH had significantly higher scores on positive action and social-support coping styles than nonabused youth. Consistent with previous research, abused youth are at higher risk for a variety of negative outcomes and are also similar in many respects to sexually abused youth who are not HIV-positive. The high frequencies of two positive styles of coping among abused YLH were also observed.     

Homicidal and suicidal sharp force fatalities in Stockholm,Sweden.: Orientation of entrance wounds in stabs gives information in the classification

A comparative study of 174 homicidal and 105 suicidal sharp force deaths in the Stockholm area is presented in order to identify variables of importance in the differentiation between homicides and suicides. In homicides, a significantly (p<0.05) higher number of cut and stab wounds were seen in the head, upper and lower extremities and a significantly higher number of vertical stab wounds were found in the chest. Lower numbers were seen in the wrist and the crook of the arm. When counting the injured areas, irrespective of the number of injuries, abdominal wounds and horizontal chest stab wounds were also significantly more often found in victims of homicide. Injuries to the back and to the genitals were not seen in suicides. The suicide victims were significantly older and had significantly lower blood alcohol levels. A new variable pointing at a statistically significant difference between homicides and suicides was found: In homicides, stab wounds with a horizontal axis of entrance wound in the chest was found to be less common than those with a vertical axis. Other variables studied were prevalence of defence and tentative wounds, farewell notes and suicidal ideation, earlier parasuicides, venue, gender of the victims and the types of sharp objects used.     

Suicides by jumping from Bosphorus Bridge in Istanbul

Suicide methods may differ widely. One of these methods is jumping from a height. The people who choose a high bridge for jumping may be considered as a special group. In this study, we evaluated the demographic data, mortality rates and postmortem findings of individuals who jumped from the 64m high Bosphorus Bridge of Istanbul. For this purpose, we reviewed registration forms of two police centers on both sides of the bridge, court archives, and postmortem examination reports of the deceased for a period of 10 years between 1986 and 1995.During this period, 65 people had jumped from the Bosphorus Bridge of Istanbul. The mortality rate was 96.9%, as two individuals survived their suicide attempt. The male/female ratio for attempts was 15:1 (61 males, four females) in this study in contrast to the male/female ratio of 1.6:1 for all suicidal cases in Turkey. The average age of subjects was 29.2 (median: 26, range: 16-54). The frequency was highest in the 15-24 age group with a rate of 38.4%. People who jumped from the bridge were younger than other reported cases of suicide. For all methods of suicide in Turkey 53.5% of subjects are under the age of 35. However, in our study, 75.8% of individuals who committed suicide from the Bosphorus Bridge were under the age of 35. Unmarried people accounted for 56% of the individuals whose marital status was known. 20.8% of the individuals whose employment status was known were unemployed. 59% of the cases whose education was known were high school graduates. The highest rate of suicide by jumping was in 1990, and occurred during the fall and winter months, primarily between the hours of 24.00 and 06.00. The Bosphorus Bridge is forbidden to pedestrians. Arrival method to the bridge was by a taxicab in 53.3% of the cases. 91% of the recovered bodies had been discovered during the first 2 days of jumping. Positions on impact with the water were estimated according to external and internal injuries. Among the cases in which the position of impact could be assessed by external and internal injury patterns, combined lateral and horizontal positions were most common.     

Personality traits in suicidal and homicidal subjects with schizophrenia

Paranoid schizophrenia is characterised by an increased risk of suicide and homicide. Little is known about the influence of personality dimensions as determinants for suicidal and homicidal behaviour within this condition. We assessed the differences among suicidal, homicidal and non-aggressive adult male in-patients with ICD-10 paranoid schizophrenia. The clinical assessments included structured psychiatric interviews and reports on harmful alcohol use and suicide attempts. The personality dimensions were assessed with the Big Five Inventory-10. The study recruited 264 patients divided into three groups: suicide attempters (N = 62), homicide group (N = 70), and a comparative control group (N = 132). To examine how the clinical subgroups differed from the comparative sample in the studied variables, a multinomial regression was performed. Each subgroup was considered a nominal outcome variable and the log odds of the outcomes were modelled as a linear combination of the predictor variables. Neuroticism or emotional instability was the only personality dimension that was different among the study subgroups: a lower level of neuroticism was found in the homicide group. Other risk factors such as age, education, relationship status and history of self-aggressive behaviour could potentially distinguish these subgroups of paranoid schizophrenia patients.