Social and economic burden of suicides in Hong Kong SAR: a year of life lost perspective

The paper proposes to use the years-of-life-lost method (YLL) in assessing the social and economic burden of suicides in Hong Kong SAR. The YLL from suicide by age group in 1981-2002 is calculated based on the standard set by World Health Organization (WHO). It shows that the middle age group (25-39) contributed most to the burden of disease in Hong Kong. The proportion of older adults' suicides is about 25% of the total number of suicides but its disease burden is less than 6% in terms of the YLL. Though the group aged 25-39 contributed disproportionately to the total YLL from suicide, the prevention effort for this particular group has been very much neglected and needs to be strengthened. It illustrates that use of YLL could provide a new viewpoint for setting up public health policies.     

Trends in US emergency department visits for suicide attempts, 1992-2001

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (p(trend) = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50-69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.     

Suicide rates and mental health services in modern China

Suicide rates in China have in the past been reported to be very low for a variety of historical and political reasons. In recent years, however, the reported suicide rates in China have increased alarmingly among certain age groups. This article reviews reports of the national rural suicide rates in China for 1992, gathered from the Annal of Chinese Public Health, which has previously never been reported publicly. The highest suicide rates occur in the rural areas and among young women and men over 60 years. These data reveal that suicide in China may have some unique characteristic associated with a variety of socio-cultural variables, such as traditional culture, social class, economic status, health care levels, and interpersonal problems. The author shows that lack of mental health services in rural areas in China may be considered one of associated reasons to the high rural suicide rate in China.     

Suicide to harass others: clues from mythology to understanding suicide bombing attacks

Suicide by revenge, the Samsonic suicide, and the suicide by devotio, all described in classical mythology and also reported in the ethnographic literature, belong to the same class of suicidal behaviors as kamikaze suicide and the suicide bombing attack: suicide to harass and burden others or suicide with a hostile intent. The lack of a social dimension to share in a positive manner may lead an individual to integrate him/herself in another social structure, e.g., a military organization, which allows the individual to express his/her desires and personal identity only by destroying others and themselves. The dynamics of these forms of suicide are also likely to work in other displays of life-threatening behavior, such as family annihilation, mass murder, and spree killing. A more thorough investigation of the dynamics operating in suicide bombing attacks could, therefore, contribute to preventative strategies against violence at large.     

Suicidal behavior in the Ukraine, 1988-1998

This report studies the available data concerning suicide rates in the Ukraine and points to the importance of appropriate monitoring of suicides and attempted suicides. It illustrates the necessity of collecting this information and of developing "The Ukrainian National Program on Suicide Prevention." Unfortunately, suicide research and publications about suicide rates were prohibited in the former Soviet Union, so some of the data about suicidal behavior in the Ukraine is incomplete. We used the official suicide death statistics of the Ukraine from the Center of Statistics (Ukrainian Ministry of Health) for the period 1988-1998. The overall rate of suicide in the Ukraine is relatively high. Official statistics in the Ukraine show that there were 29.6 suicides per 100,000 population in 1998. The frequency of completed suicide differs in the various regions of the country, suicides being more frequent in the industrially developed regions and in the rural areas of the country than in the cities. In the western part of the Ukraine the frequency of suicide is relatively low (11.1 per 100,000). Between 1988 and 1997 the suicide rate increased by 57%. In 1998 the suicide rate for women was approximately five times lower than that for men.     

High rates of suicide and attempted suicide using pesticides in Nickerie, Suriname, South America

Suicide and attempted suicide are identified as a serious mental health problem in Suriname, especially in the district of Nickerie. An epidemiological study in the Nickerie catchment area revealed high rates of suicide (48 per 100,000) and attempted suicide (207 per 100,000) on average in the years 2000-2004. Particularly remarkable is the high number of attempted suicides among males (49%), and the use of pesticides in both fatal (55%) and nonfatal suicidal behavior (44%). Probably this high incidence of suicidal behavior reflects the very poor economic situation of the district, poverty of most of the population, high levels of alcohol misuse, domestic violence, the rigidity of Hindustani culture regarding family traditions, the accessibility of pesticides, and the lack of future perspectives. Health care alone will not be sufficient to tackle this problem. One of the most urgent measures to prevent suicides is to stow away pesticides in locked cabinets with the key held by the proprietor.     

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.     

Suicide and changing values and beliefs in Ireland

This paper addresses some of the generalized theories explaining rising suicide rates in Ireland. The conclusion here is that linking suicide patterns to changing beliefs and values is problematic. Church attendance as well as adherence to traditional values remain high in this country compared to European levels, and variations in beliefs and values, especially rural/urban differences, do not fit with general explanations. Moreover, attitudes to value areas fluctuate in that justification for suicide--which showed an upward trend in the 1980s--was reversed in the 1990s, and this may have resulted from increased public focus and debate. Generalized explanations are unlikely to decipher complex phenomena such as suicidal behavior. Religious belief, if protective in relation to suicide, is unlikely to act alone. Social transformations have a differential impact depending on one's socio-economic positioning, which translates ideas of a general male vulnerability to suicide into focused areas of male distress.     

Risk of suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in university students

The present paper investigates the risk of lifetime suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in a sample of 328 university students (41% male, 59% female). The response rate was 77% based on the total number of students registered for the relevant courses. A series of questions assessed lifetime suicide ideation, while problem solving and attitudes toward suicide were measured using the Self-Rating Problem Solving scale and four subscales of the Suicide Opinion Questionnaire, respectively (McLeavey, 1986; Domino et al., 1989). Almost one-third of the students surveyed had lifetime suicide ideation. Both genders were similar in terms of their suicide ideation history, problem solving, and attitudes toward suicidal behavior with the exception that male students were more in agreement with the attitude that suicidal behavior lacks real intent. Compared with 2% of nonideators and ideators, one in four planners reported that they would more than likely attempt suicide at some point in their life. Greater agreement with the attitude that suicidal behavior is normal was associated with significantly increased risk of being an ideator, as was poor problem solving and less agreement with the attitude that suicidal behavior is associated with mental illness.     

Suicide,gender, and age variations in India. Are women in indian society protected from suicide?

A new set of data concerning the pattern of suicide in India between 1991-1997 are presented. Suicide rates rose over this period despite a small decline in the Indian suicide rate in 1995 and 1996. It was found that between 1995 and 1997 there was a modest fall in the suicide rates among under 29-year-olds of both sexes, and an increase among those 30 years and older. The pattern of suicides in India is bimodal: the incidence of suicides is highest for those in the 30-44-year-old category of both sexes and tends to decline in higher age categories. Suicide rates were nearly equal for young women and men, a contrast with the pattern of suicide sex ratios in eight developed countries.     

Child and adolescent suicide deaths in New Mexico, 1990-1994

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.     

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.     

History of childhood abuse and neglect and suicidal behavior at hospital admission

Suicide is a major public health problem. Preventive measures have been sought by identifying risk factors. This study evaluates the association of childhood abuse and neglect with suicidal behavior at the time of psychiatric hospital admission. A total of 120 subjects (72 females; mean age 42.5 +/- 15.6 years old) admitted from August 2006 to July 2007 completed the Childhood Trauma Questionnaire (CTQ) to assess severity of exposure to childhood maltreatment. Thereof 62 (51.6%) patients presented with suicidal behavior at admission. Patients who had attempted suicide had significantly higher CTQ scores. Regression analysis indicated that shorter illness duration and severity of childhood maltreatment were predictors of suicidal behavior at admission. The study showed that inpatients of a psychiatric unit of a general hospital who experienced severe childhood abuse or neglect were significantly more likely to present with suicidal behavior. History of childhood maltreatment should be evaluated as an associated risk factor of suicidal behavior at admission of psychiatric inpatients.     

A pilot study of the suicide victim's last contact with a health professional

Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their last contact. This was more likely to occur when the deceased presented as depressed, was aged < 60 years or seen by a psychiatrist. None was assessed to be suicidal. The family informants regarded nine of the suicide victims to have been suicidal before death but informed a health care professional in only one third of the cases. Critical information that might have altered the management is not often accessed from family members.     

Consumption,savings and investment by social class in Bangladesh: Does the rural sector support the Urban sector?

This article employs input‐output analysis and information from a social accounting matrix and the concept of net savings to examine savings, consumption and investment behaviour by various social classes in Bangladesh in urban and rural areas. Considerable differences between social classes can be identified in all three respects. A majority of the social classes in the rural sector does not appear to generate enough savings to sustain its consumption whereas the urban social classes do. There seems to be little difference in consumption pattern of the rural rich and the urban rich. There is considerable urban‐rural difference in the import intensities of consumption. The findings of this study based on the Hazari model do not establish the existence of urban bias but the problem seems to be one of ‘rich‐bias’ rather than urban‐bias per se. However, the Hazari model cannot capture all possible sources of urban bias and circumstantial evidence indicates concentration of advantages in the urban areas.     

Poverty in Bangladesh: Measurement,decomposition and intertemporal comparison

This article, using the methodology developed by Foster, Greer, and Thorbecke to measure and decompose poverty, provides estimates of the levels of poverty in rural and urban areas in Bangladesh. It investigates in the context of Bangladesh, the most powerful effect of poverty in terms of a shortfall in food for daily calorie intake by the poor. It provides intertemporal comparison of poverty and its decomposition among subgroups. It also makes comparisons between the results obtained in this study with those currently available. The results of the study show a significant improvement in poverty situations in rural areas from 1982 to 1986. The article also discusses the policy implications of its findings.     

Internal migration in Turkey: Socioeconomic characteristics by destination and type of move, 1965–70

Based on examination of internal migration in Turkey during the 1965-70 period, the demographic and socioeconomic characteristics of migrants and the variation in these properties by type of move undertaken (first, repeat, and return migration) and by choice of destination are described. The volume, rates, and differentials of migration are discussed in this context. A very rapid rural-urban migration occurred in the 1950-70 period; urban population increased from 18.8 to 35.8% of the total. The emphasis on industrialization, the mechanization and relatively slower growth of agricultural production, the scarcity of new lands to cultivate, and the construction of a large road network connecting cities with their hinterland and rural communities contributed to this increased movement. The 1970 Turkish census questionnaire included a question on "place of usual residence 5 years ago" for the 1st time. Along with information on place of birth and usual residence in 1970, the census provides information on place of residence at 3 points in time. The study is based on a 1/1000 sample selected from the household records of the 1970 Population Census of Turkey. Discussion is restricted to the migration of the adult population; the migration of children (up to age 15), which is viewed as involuntary is excluded. The working file contains 20,602 cases. Variables analyzed include age, sex, education, labor force status, occupation, and place of residence in 1970. The migration-defining variables are province of birth and usual residence in 1965 and 1970. Census data indicated that 9.2% of the population 15 years of age and older changed their place of residence during the 1965-70 period, moving to another province. An additional 4% moved to another place within the same province. There were strong indications of stage migration, if movements both within and between provinces are considered. All urban places showed population grew through intraprovincial migration. Only large metropolitan cities have grown through interprovincial migration. Migrants from rural areas 1st move to towns and cities within the same province and then make a 2nd move to other, mostly larger, urban areas and metropolitan cities. The majority of the interprovincial migrants (60%) were interurban movers, and only 1/5 were rural to urban migrants. +a large group of repeat migrants who moved primarily between urban places, were relatively older, better educated and skilled, and more likely to be employed in white-collar occupations than their counterparts. Although interprovincial migration was dominated by young and single males, there was considerable variation in migrant properties according to the type of move made and the place of destination. Socioeconomic characteristics of the 2 basic migration types are included.     

Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality

Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.     

Modernisation and Time Preferences in Tanzania: Evidence from a Large-Scale Elicitation Exercise

Assumptions about individual time preferences are important for explanations of poverty and development. Data from a large-scale elicitation exercise in Tanzania show significantly higher levels of impatience in urban areas than in rural areas. This result remains robust to adding controls for socio-economic differences between rural and urban areas, which possibly correlate with time preferences. We attribute this to differences in ‘modernisation’ between urban and rural areas, with modernisation leading to increased impatience. This is corroborated by the observed positive correlation between impatience and education; the latter being an important vehicle of modernisation for traditional societies in Tanzania.     

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.