Restrictions in Means for Suicide: An Effective Tool in Preventing Suicide: The Danish Experience

Department of Psychiatry, Bispebjerg Hospital, Copenhagen, Denmark.
Suicide and Life-Threatening Behavior (Impact Factor: 1.4). 01/2008; 37(6):688-97. DOI: 10.1521/suli.2007.37.6.688
Source: PubMed


Restriction of means for suicide is an important part of suicide preventive strategies in different countries. The effect on method-specific suicide rate and overall suicide rate of restrictions on availability of carbon monoxide, barbiturates, and dextropropoxyphene was examined. From 1970 to 2000, overall suicide mortality and method-specific suicide mortality in Denmark were compared with official information about availability of barbiturates and analgesics and carbon monoxide in vehicle exhaust and household gas. Restrictions on availability of household gas with carbon monoxide content and barbiturates was associated with a decline in the number of suicides and suicides by self-poisoning with these compounds after controlling for the effect of calender year. Restricted access occurred concomittantly with a 55 percent decrease in suicide rate.

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    • "Such findings highlight the high lethality of firearms and prior research has demonstrated that, in contrast to most other methods, firearms almost invariably result in death when utilized in a suicide attempt (Chapdelaine et al., 1991; Spicer and Miller, 2000). Research has repeatedly demonstrated that limiting access to highly lethal means results in decreased overall suicide rates (Carrington, 1999; Kreitman, 1976; Loftin et al., 1991; Nordentoft et al., 2010; Oliver and Hetzel, 1972; Sarchiapone et al., 2011) and that the notion of method substitution – seeking out another suicide method when access to one method is thwarted – is not supported by data (Daigle, 2005; Law et al., 2014; Lester and Abe, 1998). Furthermore, recent research has demonstrated that several state laws regulating access and exposure to handguns are associated with lower overall suicide rates (Anestis et al., 2015a, 2015b; Anestis and Anestis, 2015). "
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    ABSTRACT: Background: Suicide prevention efforts often center on the identification of risk factors (e.g., prior suicide attempts); however, lists of risk factors without consideration of context may prove incapable of impacting suicide rates. One contextual variable worth considering is attempt method. Methods: Utilizing data from the National Violent Death Reporting System (2005-2012), I examined suicide deaths (n=71,775) by firearms and other means to determine whether prior suicide attempts were more common in one group versus the other. Results: Significantly fewer suicide decedents who died by firearms reported a prior history of suicide attempts (12.10%) than did decedents who died by other means (28.66%). This result was further replicated within each state that contributed data to the NVDRS. Limitations: Only 17 states have contributed to the NVDRS thus far and, within those states, not all suicide deaths were reported. Due to the nature of the data, I was unable to test proposed mediators within our model. Conclusions: Suicide decedents who die by firearms may die on their first attempt more often than other decedents due to a capability and willingness to utilize a highly lethal means. Current risk assessment protocols may be ill equipped to identify such individuals prospectively on their own. Broader methods of implementing means restriction (e.g., legislation) may thus be pivotal in suicide prevention efforts.
    Journal of Affective Disorders 09/2015; 189. DOI:10.1016/j.jad.2015.09.007 · 3.38 Impact Factor
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    • "OTC packages accounted for 58% of the total number of doses of paracetamol in 2008 [9]. The relationship between drug availability and suicide attempts is recognized, which made this decision controversial [10]. In 2003, the proportion of paracetamol poisonings in Oslo was 12% (n = 116) [3]. "
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    ABSTRACT: Background Up to date information on poisoning trends is important. This study reports the epidemiology of all hospitalized acute poisonings in Oslo, including mortality, follow-up referrals, and whether the introduction of over-the-counter sales of paracetamol outside pharmacies had an impact on the frequency of poisonings. Methods All acute poisonings of adults (≥16 years) treated at the five hospitals in Oslo from April 2008 to April 2009 were included consecutively in an observational cross-sectional multicentre study. A standardized form was completed by the treating physician, which covered the study aims. All deaths by poisoning in and outside hospitals were registered at the Institute of Forensic Medicine. Results There were 1065 hospital admissions of 912 individuals; 460 (50%) were male, and the median age was 36 years. The annual incidence was 2.0 per 1000. The most frequent toxic agents were ethanol (18%), benzodiazepines (15%), paracetamol (11%), and opioids (11%). Physicians classified 46% as possible or definite suicide attempts, 37% as accidental overdoses with substances of abuse (AOSA), and 16% as other accidents. Twenty-four per cent were discharged without any follow-up and the no follow-up odds were highest for AOSA. There were 117 deaths (eight in hospital), of which 75% were males, and the median age was 41 years. Thus, the annual mortality rate was 25 per 100 000 and the in-hospital mortality was 0.8%. Opioids were the most frequent cause of death. Conclusions The incidence of hospitalized acute poisonings in Oslo was similar to that in 2003 and there was an equal sex distribution. Compared with a study performed in Oslo in 2003, there has been an increase in poisonings with a suicidal intention. The in-hospital mortality was low and nine out of ten deaths occurred outside hospitals. Opioids were the leading cause of death, so preventive measures should be encouraged among substance abusers. The number of poisonings caused by paracetamol remained unchanged after the introduction of over-the-counter sales outside pharmacies and there were no deaths, so over-the-counter sales may be considered safe.
    BMC Public Health 10/2012; 12(1):858. DOI:10.1186/1471-2458-12-858 · 2.26 Impact Factor
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    • "There is evidence in literature supporting suicide means reduction as an effective preventive strategy [9,10]. In the present review we aimed to summarize methods of suicide attempts and studies addressing and evaluating the possibility to restrict access to such methods as preventive strategies for suicide attempt. "
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    ABSTRACT: 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. 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. 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. 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.
    International Journal of Environmental Research and Public Health 12/2011; 8(12):4550-62. DOI:10.3390/ijerph8124550 · 2.06 Impact Factor
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