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Special Issue "Suicide Prevention and Public Health"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2011)

Special Issue Editors

Guest Editor
Prof. Dr. Danuta Wasserman

Department of Public Health Sciences, The National Prevention of Suicide and Mental Ill-Health (NASP), Karolinska Institute (KI), SE-171 77 Stockholm, Sweden
Website | E-Mail
Guest Editor
Prof. Dr. Gustavo Turecki

Department of Psychiatry, McGill University/ Douglas Mental Health Institute, Frank B. Common Pavilion, F-2101, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
Website | E-Mail
Interests: suicide; depressive disorders; early-life adversity; neurobiology; epigenetics

Special Issue Information

Dear Colleagues,

According to WHO estimates, approximately one million people die each year from suicide worldwide, and approximately 10-20 times that number will attempt suicide. Among the age group 15-34 years, suicide ranks second in some European countries as the most common cause of death, following traffic and other accidents. It is imperative to recognize that these fatalities can be avoided given that suicide is preventable.

There are essential strategies in suicide prevention that prove invaluable. One recognized conceptual strategies in suicide prevention is the Universal/Selective/Indicated (U.S.I.) model. The USI scheme has both a temporal perspective and target population perspective. Universal prevention is primarily aimed at general populations, e.g. the limitation of access to toxic substances, which are used as means of suicide and increasing awareness about prevention of mental ill-health and suicide. Selective prevention targets subgroups that are at increased risk for suicidal behavior, e.g. treatment of people with mental disorders and substance use disorders, psychological support to persons in crisis situations or with physical disabilities. Indicated prevention is directed at persons who have already experienced symptoms. For instance, an intervention in the indicated scheme is treatment and close follow-up of people with depression, bipolar disorders, recurrent psychotic episodes and intensive psychosocial follow-up of suicide attempters.

Suicide prevention strategies can be healthcare or public health oriented. Health care oriented schemes use the individual-centered approach with the focus on early diagnosis of psychiatric disorders (e.g. depression), treatment of patients, attitudes toward suicide and suicide prevention among healthcare staff. Public health strategies, in prevention of suicide, are directed toward groups and whole populations. Its objectives are to promote mental health policies and education about prevention of mental ill-health and suicide in working places, schools, etc.as well as education of general public about prevention of mental problems and about treatment of mental disorders.

It is important to integrate various conceptual frameworks and strategies in order to maximize their effectiveness. Prevention of suicide should always involve a whole series of activities, ranging from improving conditions for bringing up children and young people, to controlling environmental risk factors, to giving the best effective treatment of mental disorders both in the community and within the mental health care services. Given the importance of suicide prevention and the need to better integrate various conceptual frameworks and strategies, additional work and debates are needed.

Prof. Dr. Danuta Wasserman
Prof. Dr. Gustavo Turecki
Guest Editor

Keywords

  • suicide
  • attempted suicide
  • prevention
  • public-health
  • awareness

Published Papers (20 papers)

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Research

Jump to: Review

Open AccessArticle Wars and Suicides in Israel, 1948–2006
Int. J. Environ. Res. Public Health 2012, 9(5), 1927-1938; doi:10.3390/ijerph9051927
Received: 13 March 2012 / Accepted: 11 May 2012 / Published: 18 May 2012
Cited by 5 | PDF Full-text (87 KB) | HTML Full-text | XML Full-text
Abstract
This paper reports the characteristics of suicides which occurred during the existential and the non-existential wars in Israel. It provides a first approximation of whether the suicide patterns in each war are consistent with the findings of Morselli and Durkheim, and whether their
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This paper reports the characteristics of suicides which occurred during the existential and the non-existential wars in Israel. It provides a first approximation of whether the suicide patterns in each war are consistent with the findings of Morselli and Durkheim, and whether their theoretical interpretations can serve as a preliminary guideline to explaining the Israeli case, which is characterized by short periods of war, social integration during some of the non-existential wars, and a sharp rise in post-war male suicide rates following all of the existential wars. Implications for further studies on the subject in Israel and elsewhere are discussed. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Suicide Mortality in Comparison to Traffic Accidents and Homicides as Causes of Unnatural Death. An Analysis of 14,441 Cases in Germany in the Year 2010
Int. J. Environ. Res. Public Health 2012, 9(3), 924-931; doi:10.3390/ijerph9030924
Received: 4 January 2012 / Revised: 23 February 2012 / Accepted: 7 March 2012 / Published: 15 March 2012
Cited by 6 | PDF Full-text (324 KB) | HTML Full-text | XML Full-text
Abstract
Aim: To assess suicide mortality in comparison to traffic accidents and homicide deaths in Germany in the year 2010 and to compare years of life lost (YLL) due to these unnatural deaths. Methods: Mortality data were provided by the Federal Statistical
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Aim: To assess suicide mortality in comparison to traffic accidents and homicide deaths in Germany in the year 2010 and to compare years of life lost (YLL) due to these unnatural deaths. Methods: Mortality data were provided by the Federal Statistical Office giving death rates (related to 100,000 inhabitants) and proportions (related to 100 deaths of individuals) for suicide, traffic accidents and homicide as well as YLL data. Results: A total of 14,441 unnatural deaths (suicide, traffic accidents, homicide) were reported in 2010 in Germany. Of those, 10,021 subjects (69.4%) committed suicide, 3,942 (27.3%) died in traffic accidents, 478 (3.3%) were murdered. Suicide death rates were by far the highest, with rates for men (18.6) three times higher than for women (6.1). For both sexes, suicide rates increased with age, whereas suicide as a proportion of all causes of death was higher in younger age groups. In both sexes, suicide was the leading cause of YLL (men: 314 YLL, women: 90 YLL). Conclusions: Suicide is the leading cause of unnatural death and YLL. The sex- and age- specific patterns in suicide mortality call for different action plans to target high risk groups. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
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Open AccessArticle Patterns of Suicide and Other Trespassing Fatalities on State-Owned Railways in Greater Stockholm; Implications for Prevention
Int. J. Environ. Res. Public Health 2012, 9(3), 772-780; doi:10.3390/ijerph9030772
Received: 13 January 2012 / Revised: 22 February 2012 / Accepted: 2 March 2012 / Published: 5 March 2012
Cited by 7 | PDF Full-text (249 KB) | HTML Full-text | XML Full-text
Abstract
Each year, approximately 80–100 people are killed on state-owned railways due to train-person collisions in Sweden. Underlying causes are suicide and accidents; suicide constituting a vast majority. Earlier Swedish studies at a national level revealed a relation between population density and incident frequency,
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Each year, approximately 80–100 people are killed on state-owned railways due to train-person collisions in Sweden. Underlying causes are suicide and accidents; suicide constituting a vast majority. Earlier Swedish studies at a national level revealed a relation between population density and incident frequency, however, with places of occurrence often located to the outskirts of cities some distance away from station areas where victims can await approaching trains in seclusion. The aim of this study was to investigate whether this national pattern also applies to larger urban areas such as greater Stockholm, and to discuss preventative implications based on these observations. All registered incidents (N = 41) where people were hit or run-over by trains with a fatal outcome over the four-year period 2005–2008 were investigated. Results deviating from the national pattern include that most incidents occur at station areas, and that most victims enter the tracks from platforms. Passing express trains appear to be overrepresented, compared to commuter trains. Due to a low number of cases, our observations must be interpreted with caution. However, they imply that preventative measures in this type of area should focus on platform safety foremost, especially protection against rapid trains passing by station areas. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Suicide in the World
Int. J. Environ. Res. Public Health 2012, 9(3), 760-771; doi:10.3390/ijerph9030760
Received: 2 February 2012 / Revised: 13 February 2012 / Accepted: 22 February 2012 / Published: 2 March 2012
Cited by 113 | PDF Full-text (349 KB) | HTML Full-text | XML Full-text
Abstract
Introduction: Over the past 20 years the WHO has considerably improved world mortality data. There are still shortcomings but more countries now report data and world-wide estimates are regularly made. Methods: Data about mortality have been retrieved from the WHO world
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Introduction: Over the past 20 years the WHO has considerably improved world mortality data. There are still shortcomings but more countries now report data and world-wide estimates are regularly made. Methods: Data about mortality have been retrieved from the WHO world database. Worldwide injury mortality estimates for 2008 as well as trends of the suicide rate from 1950 to 2009 were analysed. Results: Suicides in the world amount to 782 thousand in 2008 according to the WHO estimate, which is 1.4% of total mortality and 15% of injury mortality. The suicide rate for the world as a whole is estimated at 11.6 per 100,000 inhabitants. The male–female rate ratio of suicide is estimated to be highest in the European Region (4.0) and the lowest in the Eastern Mediterranean region (1.1). Among males the highest suicide rate in the 15–29 age group is in the SE Asian region, in the 45–59 age group in European males and for ages above 60 in the Western Pacific region. Females from SE Asia have a remarkably high suicide rate among 15–29-year-olds and from age 45 in the Western Pacific region. The leading country is currently Lithuania, with a suicide rate of 34.1 per 100,000 inhabitants. Also among males the suicide rate is the highest in Lithuania at 61.2. Among females South Korea with 22.1 is at the top of world suicide rates. Conclusions: During the past six decades, according to the WHO Japan, Hungary, and Lithuania have topped the list of world countries by suicide rate, but if the current trends continue South Korea will overtake all others in a few years. The heart of the problem of suicide mortality has shifted from Western Europe to Eastern Europe and now seems to be shifting to Asia. China and India are the biggest contributors to the absolute number of suicides in the world. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Effects of Educating Local Government Officers and Healthcare and Welfare Professionals in Suicide Prevention
Int. J. Environ. Res. Public Health 2012, 9(3), 712-721; doi:10.3390/ijerph9030712
Received: 16 January 2012 / Revised: 2 February 2012 / Accepted: 21 February 2012 / Published: 29 February 2012
Cited by 4 | PDF Full-text (208 KB) | HTML Full-text | XML Full-text
Abstract
Suicide is a major public health issue. In Japan, local governments are responsible for suicide prevention, and local government officers are therefore expected to act as gatekeepers for suicide prevention. In this study, through a questionnaire survey, the authors examined the current knowledge
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Suicide is a major public health issue. In Japan, local governments are responsible for suicide prevention, and local government officers are therefore expected to act as gatekeepers for suicide prevention. In this study, through a questionnaire survey, the authors examined the current knowledge and attitudes concerning suicide prevention among local government officers and healthcare and welfare professionals, and the effects of providing suicide prevention education on their knowledge of and attitudes toward suicide and its prevention. One hundred eighty-three local government officers and 432 healthcare/welfare professionals completed the survey before and after a single education session. Before the session, the local government officers and healthcare/welfare professionals showed mainly positive attitudes toward suicide prevention efforts, with little difference between the two groups. After the training, knowledge and attitudes were further improved for most questionnaire items. Respondents with one or more experiences of suicide prevention training showed significantly more knowledge and positive attitudes before the training than those with no such experience. Moreover, knowledge of depression and having a sympathetic attitude were found to be especially associated with the overall attitude that “suicide can be prevented”. Training in suicide prevention was shown to be effective in promoting appropriate knowledge and attitudes among local government officers and healthcare/welfare professionals who are gatekeepers for preventing suicide. Our findings confirm the importance of suicide prevention education, and will contribute to creating a standard educational program on suicide prevention in Japan. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala
Int. J. Environ. Res. Public Health 2012, 9(2), 596-609; doi:10.3390/ijerph9020596
Received: 28 December 2011 / Revised: 21 January 2012 / Accepted: 6 February 2012 / Published: 16 February 2012
Cited by 17 | PDF Full-text (308 KB) | HTML Full-text | XML Full-text
Abstract
While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the
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While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Age, Gender and Suicidal Ideation Following Voluntary HIV Counseling and Testing
Int. J. Environ. Res. Public Health 2012, 9(2), 521-530; doi:10.3390/ijerph9020521
Received: 21 December 2011 / Revised: 26 January 2012 / Accepted: 6 February 2012 / Published: 10 February 2012
Cited by 9 | PDF Full-text (261 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this study was to determine the prevalence of suicidal ideation in patients who were tested for HIV-infection and whether along with their HIV status, age and gender influenced their risk for suicidal ideation. The sample consisted of 189 patients who
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The aim of this study was to determine the prevalence of suicidal ideation in patients who were tested for HIV-infection and whether along with their HIV status, age and gender influenced their risk for suicidal ideation. The sample consisted of 189 patients who attended a voluntary HIV counseling and testing clinic (VCT) at a general state hospital in Durban, South Africa. Their mean age at baseline was 34.2 years, with an age range of between 16–79 years. Seropositivity, age and gender were significantly associated with suicidal ideation. The majority of these patients were in the younger age group, and young males had a 1.8 times higher risk for suicidal ideation than females. Although risk factors for seropositive-related suicidal ideation can be complex and multi-factorial, this study identified a young age and male gender as important high risk factors in the sample studied. It is recommended that all, but especially young male HIV-infected patients seen at a VCT clinic be screened for suicidal ideation and that early intervention to prevent subsequent suicides or suicidal attempts be included in pre- and post-test HIV counseling. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Suicidal Ideation and Associated Factors among School-Going Adolescents in Thailand
Int. J. Environ. Res. Public Health 2012, 9(2), 462-473; doi:10.3390/ijerph9020462
Received: 21 December 2011 / Revised: 11 January 2012 / Accepted: 21 January 2012 / Published: 31 January 2012
Cited by 15 | PDF Full-text (338 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this study was to estimate the prevalence and identify associations between suicidal ideation and indicators of psychosocial distress and social-environmental factors in Thai adolescents. Using data from the Thailand Global School-Based Student Health Survey (GSHS) 2008, we assessed the prevalence
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The aim of this study was to estimate the prevalence and identify associations between suicidal ideation and indicators of psychosocial distress and social-environmental factors in Thai adolescents. Using data from the Thailand Global School-Based Student Health Survey (GSHS) 2008, we assessed the prevalence of suicidal ideation and its associated factors among adolescents (N = 2,758). Overall the prevalence of suicidal ideation in the past 12 months was 8.8% (9.9% males and 7.7% females). Variables influenced the suicidal ideation in multivariable analysis were sadness (Odds Ratio = OR: 6.03; 95% Confidence Interval = CI (3.00–12.14), lack of parental attachment (OR = 2.26, CI = 1.09–4.67), current alcohol use (OR = 2.32, 1.21–4.44), and ever having had sexual intercourse (OR = 4.16, CI = 3.40–7.68). Psychosocial, health-risk behaviours and lack of protective factors appear to effect suicidal ideation in this youth population. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors
Int. J. Environ. Res. Public Health 2012, 9(1), 178-191; doi:10.3390/ijerph9010178
Received: 9 November 2011 / Revised: 13 December 2011 / Accepted: 5 January 2012 / Published: 11 January 2012
Cited by 21 | PDF Full-text (291 KB) | HTML Full-text | XML Full-text
Abstract
The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a
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The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring) associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Essential Questions on Suicide Bereavement and Postvention
Int. J. Environ. Res. Public Health 2012, 9(1), 24-32; doi:10.3390/ijerph9010024
Received: 8 November 2011 / Revised: 12 December 2011 / Accepted: 21 December 2011 / Published: 27 December 2011
Cited by 14 | PDF Full-text (214 KB) | HTML Full-text | XML Full-text
Abstract
During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series
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During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series of essential issues on suicide bereavement and postvention, regarding the current state of the art and future developments. Who is a suicide survivor and how many suicide survivors are there? Is suicide bereavement different from other types of bereavement? What are the needs of suicide survivors and what is postvention from a clinical perspective and from a public health perspective? Can postvention be prevention? With this last question, the article concludes with a series of recommendations in order to strengthen the potential of postvention as prevention. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle MATES in Construction: Impact of a Multimodal, Community-Based Program for Suicide Prevention in the Construction Industry
Int. J. Environ. Res. Public Health 2011, 8(11), 4180-4196; doi:10.3390/ijerph8114180
Received: 29 August 2011 / Revised: 6 October 2011 / Accepted: 28 October 2011 / Published: 7 November 2011
Cited by 14 | PDF Full-text (813 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
A large-scale workplace-based suicide prevention and early intervention program was delivered to over 9,000 construction workers on building sites across Queensland. Intervention components included universal General Awareness Training (GAT; general mental health with a focus on suicide prevention); gatekeeper training provided to construction
[...] Read more.
A large-scale workplace-based suicide prevention and early intervention program was delivered to over 9,000 construction workers on building sites across Queensland. Intervention components included universal General Awareness Training (GAT; general mental health with a focus on suicide prevention); gatekeeper training provided to construction worker volunteer ‘Connectors’; Suicide First Aid (ASIST) training offered to key workers; outreach support provided by trained and supervised MIC staff; state-wide suicide prevention hotline; case management service; and postvention support provided in the event of a suicide. Findings from over 7,000 workers (April 2008 to November 2010) are reported, indicating strong construction industry support, with 67% building sites and employers approached agreeing to participate in MIC. GAT participants demonstrated significantly increased suicide prevention awareness compared with a comparison group. Connector training participants rated MIC as helpful and effective, felt prepared to intervene with a suicidal person, and knew where to seek help for a suicidal individual following the training. Workers engaged positively with the after-hours crisis support phone line and case management. MIC provided postvention support to 10 non-MIC sites and sites engaged with MIC, but not yet MIC-compliant. Current findings support the potential effectiveness and social validity of MIC for preventing suicide in construction workers. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessArticle Sex Differences in Suicide Incident Characteristics and Circumstances among Older Adults: Surveillance Data from the National Violent Death Reporting System—17 U.S. States, 2007–2009
Int. J. Environ. Res. Public Health 2011, 8(8), 3479-3495; doi:10.3390/ijerph8083479
Received: 29 June 2011 / Revised: 3 August 2011 / Accepted: 17 August 2011 / Published: 23 August 2011
Cited by 10 | PDF Full-text (258 KB) | HTML Full-text | XML Full-text
Abstract
Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females
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Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females are often overlooked due to low occurrence, particularly among women. The National Violent Death Reporting System (NVDRS) bridges this gap by providing detailed information on older adult suicide by sex in 17 US states (covering approximately 26% of the U.S. population). NVDRS data for 2007–2009 were used to characterize male (n = 5,004) and female (n = 1,123) suicide decedents aged 60 years and older, including incident characteristics and circumstances precipitating suicide. Stratification of NVDRS data by sex shows significant differences with regard to the presence of antidepressants (19% and 45% respectively), opiates (18%, 37%), and 14 precipitating circumstances concerning mental health, interpersonal problems, life stressors and a history of suicide attempts. No differences were found for alcohol problems, suicide/other death of family or friends, non-criminal legal problems, financial problems, or disclosure of intent to take their own life. The findings of this study demonstrate the value of using comprehensive surveillance data to understand sex-specific suicide circumstances so that opportunities for targeted prevention strategies may be considered. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)

Review

Jump to: Research

Open AccessReview Suicide among War Veterans
Int. J. Environ. Res. Public Health 2012, 9(7), 2504-2519; doi:10.3390/ijerph9072504
Received: 19 June 2012 / Revised: 8 July 2012 / Accepted: 11 July 2012 / Published: 19 July 2012
Cited by 8 | PDF Full-text (128 KB) | HTML Full-text | XML Full-text
Abstract
Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such
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Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Suicide Methods in Asia: Implications in Suicide Prevention
Int. J. Environ. Res. Public Health 2012, 9(4), 1135-1158; doi:10.3390/ijerph9041135
Received: 14 February 2012 / Revised: 13 March 2012 / Accepted: 20 March 2012 / Published: 28 March 2012
Cited by 32 | PDF Full-text (353 KB) | HTML Full-text | XML Full-text
Abstract
As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide
[...] Read more.
As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide “technologies”. It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Social Aspects of Suicidal Behavior and Prevention in Early Life: A Review
Int. J. Environ. Res. Public Health 2012, 9(3), 985-994; doi:10.3390/ijerph9030985
Received: 2 February 2012 / Revised: 5 March 2012 / Accepted: 12 March 2012 / Published: 19 March 2012
Cited by 12 | PDF Full-text (216 KB) | HTML Full-text | XML Full-text
Abstract
Purpose: The present review summarizes the updated literature on the social aspects of suicidal behavior and prevention in adolescents. Recent findings: The predictive role of psychiatric disorders and past history are well recognized in adolescent suicide, but the role of social
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Purpose: The present review summarizes the updated literature on the social aspects of suicidal behavior and prevention in adolescents. Recent findings: The predictive role of psychiatric disorders and past history are well recognized in adolescent suicide, but the role of social and cultural factors is less clear. Studies have focused on the importance of ethnicity, gender, family characteristics, and socioeconomic status. More recently, attention has been addressed to broader social risk factors, such as bullying in adolescents, suicide contagion, sexual orientation, and the popular media. Further empirical evidence is needed to advance our understanding of suicidal youth, develop better assessment tools, and formulate effective prevention and treatment programs. Summary: Suicidal behavior remains an important clinical problem and major cause of death in youth. Social factors may be at least as important as genetics. Advancing our understanding of underlying cultural and sociological issues in youth suicide will help clinicians achieve more efficient prediction, prevention and treatment. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview A Systematic Review of Social Factors and Suicidal Behavior in Older Adulthood
Int. J. Environ. Res. Public Health 2012, 9(3), 722-745; doi:10.3390/ijerph9030722
Received: 26 January 2012 / Revised: 16 February 2012 / Accepted: 22 February 2012 / Published: 1 March 2012
Cited by 51 | PDF Full-text (237 KB) | HTML Full-text | XML Full-text
Abstract
Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths)
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Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Seasonality of Suicidal Behavior
Int. J. Environ. Res. Public Health 2012, 9(2), 531-547; doi:10.3390/ijerph9020531
Received: 16 December 2011 / Revised: 11 January 2012 / Accepted: 26 January 2012 / Published: 14 February 2012
Cited by 38 | PDF Full-text (530 KB) | HTML Full-text | XML Full-text
Abstract
A seasonal suicide peak in spring is highly replicated, but its specific cause is unknown. We reviewed the literature on suicide risk factors which can be associated with seasonal variation of suicide rates, assessing published articles from 1979 to 2011. Such risk factors
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A seasonal suicide peak in spring is highly replicated, but its specific cause is unknown. We reviewed the literature on suicide risk factors which can be associated with seasonal variation of suicide rates, assessing published articles from 1979 to 2011. Such risk factors include environmental determinants, including physical, chemical, and biological factors. We also summarized the influence of potential demographic and clinical characteristics such as age, gender, month of birth, socioeconomic status, methods of prior suicide attempt, and comorbid psychiatric and medical diseases. Comprehensive evaluation of risk factors which could be linked to the seasonal variation in suicide is important, not only to identify the major driving force for the seasonality of suicide, but also could lead to better suicide prevention in general. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Media Roles in Suicide Prevention: A Systematic Review
Int. J. Environ. Res. Public Health 2012, 9(1), 123-138; doi:10.3390/ijerph9010123
Received: 10 November 2011 / Revised: 15 December 2011 / Accepted: 30 December 2011 / Published: 4 January 2012
Cited by 50 | PDF Full-text (286 KB) | HTML Full-text | XML Full-text
Abstract
The aim of the current systematic review was to monitor and provide an overview of the research performed about the roles of media in suicide prevention in order to find out possible effects media reporting on suicidal behaviours might have on actual suicidality
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The aim of the current systematic review was to monitor and provide an overview of the research performed about the roles of media in suicide prevention in order to find out possible effects media reporting on suicidal behaviours might have on actual suicidality (completed suicides, attempted suicides, suicidal ideation). The systematic review was performed following the principles of the PRISMA statement and includes 56 articles. Most of the studies support the idea that media reporting and suicidality are associated. However, there is a risk of reporting bias. More research is available about how irresponsible media reports can provoke suicidal behaviours (the ‘Werther effect’) and less about protective effect media can have (the ‘Papageno effect’). Strong modelling effect of media coverage on suicide is based on age and gender. Media reports are not representative of official suicide data and tend to exaggerate sensational suicides, for example dramatic and highly lethal suicide methods, which are rare in real life. Future studies have to encounter the challenges the global medium Internet will offer in terms of research methods, as it is difficult to define the circulation of news in the Internet either spatially or in time. However, online media can provide valuable innovative qualitative research material. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Controlling Access to Suicide Means
Int. J. Environ. Res. Public Health 2011, 8(12), 4550-4562; doi:10.3390/ijerph8124550
Received: 27 October 2011 / Revised: 15 November 2011 / Accepted: 29 November 2011 / Published: 7 December 2011
Cited by 39 | PDF Full-text (233 KB) | HTML Full-text | XML Full-text
Abstract
Background: Restricting access to common means of suicide, such as firearms, toxic gas, pesticides and other, has been shown to be effective in reducing rates of death in suicide. In the present review we aimed to summarize the empirical and clinical literature
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Background: Restricting access to common means of suicide, such as firearms, toxic gas, pesticides and other, has been shown to be effective in reducing rates of death in suicide. In the present review we aimed to summarize the empirical and clinical literature on controlling the access to means of suicide. Methods: This review made use of both MEDLINE, ISI Web of Science and the Cochrane library databases, identifying all English articles with the keywords “suicide means”, “suicide method”, “suicide prediction” or “suicide prevention” and other relevant keywords. Results: A number of factors may influence an individual’s decision regarding method in a suicide act, but there is substantial support that easy access influences the choice of method. In many countries, restrictions of access to common means of suicide has lead to lower overall suicide rates, particularly regarding suicide by firearms in USA, detoxification of domestic and motor vehicle gas in England and other countries, toxic pesticides in rural areas, barriers at jumping sites and hanging, by introducing “safe rooms” in prisons and hospitals. Moreover, decline in prescription of barbiturates and tricyclic antidepressants (TCAs), as well as limitation of drugs pack size for paracetamol and salicylate has reduced suicides by overdose, while increased prescription of SSRIs seems to have lowered suicidal rates. Conclusions: Restriction to means of suicide may be particularly effective in contexts where the method is popular, highly lethal, widely available, and/or not easily substituted by other similar methods. However, since there is some risk of means substitution, restriction of access should be implemented in conjunction with other suicide prevention strategies. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)
Open AccessReview Internet Pathways in Suicidality: A Review of the Evidence
Int. J. Environ. Res. Public Health 2011, 8(10), 3938-3952; doi:10.3390/ijerph8103938
Received: 5 September 2011 / Revised: 4 October 2011 / Accepted: 5 October 2011 / Published: 11 October 2011
Cited by 31 | PDF Full-text (393 KB) | HTML Full-text | XML Full-text
Abstract
The general aim of this study was to review the scientific literature concerning the Internet and suicidality and to examine the different pathways by which suicidal risks and prevention efforts are facilitated through the Internet. An online literature search was conducted using the
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The general aim of this study was to review the scientific literature concerning the Internet and suicidality and to examine the different pathways by which suicidal risks and prevention efforts are facilitated through the Internet. An online literature search was conducted using the MEDLINE and Google Scholar databases. The main themes that were investigated included pathological Internet use and suicidality, pro-suicide websites, suicide pacts on the Internet, and suicide prevention via the Internet. Articles were screened based on the titles and abstracts reporting on the themes of interest. Thereafter, articles were selected based on scientific relevance of the study, and included for full text assessment. The results illustrated that specific Internet pathways increased the risk for suicidal behaviours, particularly in adolescents and young people. Several studies found significant correlations between pathological Internet use and suicidal ideation and non-suicidal self-injury. Pro-suicide websites and online suicide pacts were observed as high-risk factors for facilitating suicidal behaviours, particularly among isolated and susceptible individuals. Conversely, the evidence also showed that the Internet could be an effective tool for suicide prevention, especially for socially-isolated and vulnerable individuals, who might otherwise be unreachable. It is this paradox that accentuates the need for further research in this field. Full article
(This article belongs to the Special Issue Suicide Prevention and Public Health)

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